=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699879031
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TMB ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 10/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2660 JOHN MONTGOMERY DR # 22
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95148-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-937-6135
-----------------------------------------------------
Fax | 408-937-6258
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2660 JOHN MONTGOMERY DR. #22
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95148-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-937-6135
-----------------------------------------------------
Fax | 408-937-6258
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. THOMAS BLAINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-937-6135
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 44363737
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------