1245545979 NPI number — DYNAMO EMS INC

Table of content: (NPI 1245545979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245545979 NPI number — DYNAMO EMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMO EMS 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:
1245545979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2404 SMITH RANCH RD STE 300
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:
77584-5201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-830-8916
Provider Business Mailing Address Fax Number:
832-553-3199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8700 COMMERCE PARK DR STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036-7423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-830-8916
Provider Business Practice Location Address Fax Number:
832-553-3199
Provider Enumeration Date:
08/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OGHIDE
Authorized Official First Name:
OROBOSA
Authorized Official Middle Name:
EMMANUEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-655-9053

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1000479 , 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: 218633001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".