1093904724 NPI number — MONARCH AMBULANCE LLC

Table of content: (NPI 1093904724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093904724 NPI number — MONARCH AMBULANCE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONARCH AMBULANCE LLC
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:
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:
1093904724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13107 INDIGO CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-905-3547
Provider Business Mailing Address Fax Number:
281-617-7919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13107 INDIGO CREEK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-905-3547
Provider Business Practice Location Address Fax Number:
281-617-7919
Provider Enumeration Date:
10/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
EDDIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MANAGING MEMBER DIRECTOR
Authorized Official Telephone Number:
281-905-3547

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  101286 , 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)

  • Identifier: 154964401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com