=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932480258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELFTEK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2011
-----------------------------------------------------
Last Update Date | 08/31/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1887 PEBBLE RDG APT. 7
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45150-4520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-587-9127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1887 PEBBLE RDG APT. 7
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45150-4520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ELFATIH RUSTOM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-587-9127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------