1306075189 NPI number — SAFEWAY AMBULANCE SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306075189 NPI number — SAFEWAY AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAFEWAY AMBULANCE SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAFEWAY AMBULANCE SERVICE LLC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306075189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 680406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-893-7233
Provider Business Mailing Address Fax Number:
281-893-7234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16903 RED OAK DR
Provider Second Line Business Practice Location Address:
STE 266
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77090-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-893-7233
Provider Business Practice Location Address Fax Number:
281-893-7234
Provider Enumeration Date:
07/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SHEPARD
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-893-7233

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1000293 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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