1043432305 NPI number — ABC EMERGENCY MEDICAL & TRANSFER SERVICE, INC.

Table of content: (NPI 1043432305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043432305 NPI number — ABC EMERGENCY MEDICAL & TRANSFER SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABC EMERGENCY MEDICAL & TRANSFER SERVICE, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1043432305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKSHIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77423-1463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-697-8300
Provider Business Mailing Address Fax Number:
713-697-5444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 LYERLY ST
Provider Second Line Business Practice Location Address:
SUITE B-8
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77022-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-697-8300
Provider Business Practice Location Address Fax Number:
713-697-5444
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
ERNEST
Authorized Official Middle Name:
K
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
713-697-8300

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  300119 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10030567 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000630601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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