Healthcare Provider Details

I. General information

NPI: 1336357862
Provider Name (Legal Business Name): ANAHUAC EMERGENCY CORPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MILLER STREET
ANAHUAC TX
77514-1410
US

IV. Provider business mailing address

511 MILLER STREET
ANAHUAC TX
77514-1410
US

V. Phone/Fax

Practice location:
  • Phone: 409-267-6080
  • Fax: 409-267-4247
Mailing address:
  • Phone: 409-267-6080
  • Fax: 409-267-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number036001
License Number StateTX

VIII. Authorized Official

Name: DERRICK W WILSON
Title or Position: EMTP SUPERVISOR
Credential:
Phone: 409-267-6080