Healthcare Provider Details

I. General information

NPI: 1497464002
Provider Name (Legal Business Name): OMEGACHILDTTRANSPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18806 PROVIDENCE VALLEY TRL
RICHMOND TX
77407-2013
US

IV. Provider business mailing address

18806 PROVIDENCE VALLEY TRL
RICHMOND TX
77407-2013
US

V. Phone/Fax

Practice location:
  • Phone: 571-420-4797
  • Fax:
Mailing address:
  • Phone: 571-420-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: VICTOR AGBEMAVA
Title or Position: OWNER
Credential:
Phone: 571-420-4797