Ecmo PRN LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

ECMO PRN LLC

Practice address

1246 Mission Rd
South San Francisco, CA 94080-1212

Phone

(510) 274-0789

NPI assigned

Jan 21, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jason Chan, RN, MSN, CCRN-K

Title

Ceo

Phone

(510) 274-0789

Specialties & licenses 3

Addresses

Other names 1

• ECMO PRN LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1912537770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1246 MISSION RD",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940801212",
            "telephone_number": "510-274-0789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1246 MISSION RD",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940801212",
            "telephone_number": "510-274-0789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECMO PRN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-274-0789",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN, MSN, CCRN-K"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "242T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Perfusionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ECMO PRN LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ross A. Dykstra, MD
• E & P Evangelista and Associates
• Early Horizon Home Care
• Early Horizon Home Care/Generations Care Home II
• Laura Echeverria
• Ellen Edelman, LMFT
• Deanne M Edwards, MFT
• Elijah Michael Edwards, MD
• Jason D. Eiband, MD
• Sarah El-Halees, MD

• Customized Equipment (DME) in South San Francisco, CA
• Providers in South San Francisco, CA by specialty
• Customized Equipment (DME) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.