=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700436250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAMO ENTERPRIZE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2019
-----------------------------------------------------
Last Update Date | 09/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 MAPLE ST
-----------------------------------------------------
City | ALBION
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49224-1183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-630-6119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1110 MAPLE ST
-----------------------------------------------------
City | ALBION
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49224-1183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-630-6119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL MANAGER
-----------------------------------------------------
Name | PAUL GETER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 517-630-6119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------