Healthcare Provider Details

I. General information

NPI: 1902558158
Provider Name (Legal Business Name): TERRY CORUTHERS PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TERRY CAROTHERS

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N SAM HOUSTON PKWY E STE 360E
HOUSTON TX
77060-4030
US

IV. Provider business mailing address

18734 MONTERO LN
NEW CANEY TX
77357-1770
US

V. Phone/Fax

Practice location:
  • Phone: 844-241-0854
  • Fax:
Mailing address:
  • Phone: 832-229-3943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number579198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: