=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528569175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ETS EXPRESS TRANS SYS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2018
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14032 ENDERLE CENTER DR STE 204
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-200-0900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14032 ENDERLE CENTER DR STE 204
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-200-0900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. MESFIN SHAWEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-893-3235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------