=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659604734
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI-MEDIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2009
-----------------------------------------------------
Last Update Date | 09/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9602 S CENTRAL AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90002-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-732-9156
-----------------------------------------------------
Fax | 323-292-4514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9602 S CENTRAL AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90002-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-732-9156
-----------------------------------------------------
Fax | 323-293-4514
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | MRS. LA JUNE OWENS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-732-9156
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 409296
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------