1770561649 NPI number — ANGELS EMS LLC

Table of content: (NPI 1770561649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770561649 NPI number — ANGELS EMS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELS EMS 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:
1770561649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 965
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALIEF
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77411-0965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-606-5500
Provider Business Mailing Address Fax Number:
713-981-8106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9207 COUNTRY CREEK DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036-7714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-606-5500
Provider Business Practice Location Address Fax Number:
713-981-8106
Provider Enumeration Date:
01/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EWERE
Authorized Official First Name:
AARON
Authorized Official Middle Name:
EBE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
832-606-5500

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  101333 , 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: 3737218 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: AMB720 . This is a "BLUECROSS BLUESHIELD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 81-00145 . This is a "EVERCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 270443 . This is a "AMERIGROUP-TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0007723632 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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