=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548590185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEAN AIR CAB, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2010
-----------------------------------------------------
Last Update Date | 01/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 W MAIN ST
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85201-6911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-777-9777
-----------------------------------------------------
Fax | 480-339-8299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 W MAIN ST
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85201-6911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-777-9777
-----------------------------------------------------
Fax | 480-339-8299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MARKETING MANAGER
-----------------------------------------------------
Name | BRITTANY BENNETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-266-5129
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | 34218
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------