MEDICARE: BRUCE C KNIGHTON SR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	800154	TX

General Provider Information

NPI Number	:	1104948900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE C KNIGHTON SR

Provider Business Mailing Address
First Line	:	2626 SOUTH LOOP WEST
Second Line	:	SUITE 340
City	:	HOUSTON
State	:	TX
Zip	:	77054
Country	:	US
Telephone Number	:	713-674-4062
Fax Number	:	713-669-1091

Provider Business Practice Location Address
First Line	:	8715 TILGHAM ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-3337
Country	:	US
Telephone Number	:	713-674-4062
Fax Number	:	713-669-1091

Authorized Official
Title or Position	:	OWNER
Name	:	BRUCE KNIGHTON SR.
Credential	:
Telephone Number	:	832-483-7994

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	06/16/2008

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