MEDICARE: PRECEDENCE AMBULANCE SERVICES LLC

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	1000473	TX

General Provider Information

NPI Number	:	1790098945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECEDENCE AMBULANCE SERVICES LLC

Provider Business Mailing Address
First Line	:	4010 HAWTHORNE GLEN CT
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-8862
Country	:	US
Telephone Number	:	832-297-6406
Fax Number	:	281-972-9594

Provider Business Practice Location Address
First Line	:	4010 HAWTHORNE GLEN CT
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-8862
Country	:	US
Telephone Number	:	832-297-6406
Fax Number	:	281-972-9594

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GREGORY TYRONE CUNNINGHAM
Credential	:
Telephone Number	:	832-297-6406

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	07/16/2010

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