1306075189 NPI number — SAFEWAY AMBULANCE SERVICE

Table of content: (NPI 1306075189)

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:
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:
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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