Healthcare Provider Details

I. General information

NPI: 1104652023
Provider Name (Legal Business Name): 5000WATSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14695 BRIAR FOREST DR APT 8107
HOUSTON TX
77077-2717
US

IV. Provider business mailing address

14695 BRIAR FOREST DR APT 8107
HOUSTON TX
77077-2717
US

V. Phone/Fax

Practice location:
  • Phone: 817-703-2997
  • Fax:
Mailing address:
  • Phone: 817-703-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. KANTERIA RONIQUE WATSON
Title or Position: CEO
Credential:
Phone: 817-703-2997