=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821232075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YASMINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2009
-----------------------------------------------------
Last Update Date | 04/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2215 W RIVER TRACE DR #4
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38134-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-336-5089
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2215W RIVER TRACE #4
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-336-5089
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NON-EMERGANC TERANSPORTION
-----------------------------------------------------
Name | MISS ORIT T AHMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-336-5089
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------