=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508001975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY MEDTRANS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2008
-----------------------------------------------------
Last Update Date | 12/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1122 B ST SUITE 306
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94541-4227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-538-5554
-----------------------------------------------------
Fax | 510-538-5556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1122 B ST SUITE 306
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94541-4227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-538-5554
-----------------------------------------------------
Fax | 510-538-5556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. UKO EDEM UMO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-538-5554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 122902
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------