=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912019381
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYLVER MEDICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 06/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1202 N LA BREA AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-412-9262
-----------------------------------------------------
Fax | 310-412-7896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1202 N LA BREA AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-412-9262
-----------------------------------------------------
Fax | 310-412-7896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. PEACE EBIRIEKWE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-412-9262
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 102809
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------