Healthcare Provider Details

I. General information

NPI: 1083365118
Provider Name (Legal Business Name): LGTIM & LIV TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6407 LAURA KOPPE ROAD
HOUSTON TX
77016
US

IV. Provider business mailing address

6407 LAURA KOPPE ROAD
HOUSTON TX
77016
US

V. Phone/Fax

Practice location:
  • Phone: 832-670-1774
  • Fax:
Mailing address:
  • Phone: 832-670-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL EARL BEAL
Title or Position: COO
Credential:
Phone: 832-670-1774