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NPI Code Detail

MEDICARE: DARK KNIGHT OSO INC

MEDICARE: DARK KNIGHT OSO INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172A00000XDriverNV20121035663NV
2311ZA0620XAdult Care Home FacilityNV20121035663NV
3343900000XNon-emergency Medical Transport (VAN)
4251B00000XCase Management Agency

General Provider Information

NPI Number : 1871865386
Entity Type Code : Organization
Provider Name (Legal Business Name) : DARK KNIGHT OSO INC
Provider Business Mailing Address
First Line : 2300 W SAHARA AVE
Second Line : SUITE 420
City : LAS VEGAS
State : NV
Zip : 89102-4352
Country : US
Telephone Number : 702-754-5255
Fax Number : 702-750-9652
Provider Business Practice Location Address
First Line : 2300 W SAHARA AVE
Second Line : SUITE 420
City : LAS VEGAS
State : NV
Zip : 89102-4352
Country : US
Telephone Number : 702-754-5255
Fax Number : 702-750-9652
Authorized Official
Title or Position : CFO
Name : MR. THERON WARD
Credential :
Telephone Number : 702-717-6971
Provider Enumeration Date : 01/30/2012
Last Update Date : 10/01/2012

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