=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871151894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIG DOG CITY CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2019
-----------------------------------------------------
Last Update Date | 06/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2060 NEWCOMB AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94124-1639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-643-9500
-----------------------------------------------------
Fax | 415-643-4144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2060 NEWCOMB AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94124-1639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-643-9500
-----------------------------------------------------
Fax | 415-643-4144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CHRISTOPHER SWEIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-518-5140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------