MEDICARE: TRIAX EMS INC

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	3416L0300X	Land Ambulance	1000512	TX

General Provider Information

NPI Number	:	1174833131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIAX EMS INC

Provider Business Mailing Address
First Line	:	5855 SOVEREIGN DR
Second Line	:	STE D-100
City	:	HOUSTON
State	:	TX
Zip	:	77036-2318
Country	:	US
Telephone Number	:	713-981-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 SOVEREIGN DR
Second Line	:	STE D-100
City	:	HOUSTON
State	:	TX
Zip	:	77036-2318
Country	:	US
Telephone Number	:	713-981-6610
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN NWAKO
Credential	:
Telephone Number	:	713-981-6610

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/11/2010

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