=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922475193
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C-PRO MEDICAL ALERT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2015
-----------------------------------------------------
Last Update Date | 08/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 390 E CORPORATE DR
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-319-6806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6918 NOAH CT #102
-----------------------------------------------------
City | CALDWELL
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83607-5288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-319-6806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER OF ACCOUNTS
-----------------------------------------------------
Name | MR. CHARLES JOHN MICHELSEN IV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-319-6806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333300000X
-----------------------------------------------------
Taxonomy Name | Emergency Response System Companies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------