Healthcare Provider Details

I. General information

NPI: 1104068295
Provider Name (Legal Business Name): STEPHEN OGAVU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8213 FARTHING LANE
ROSHARON TX
77583-6634
US

IV. Provider business mailing address

PO BOX 421854
HOUSTON TX
77242-1854
US

V. Phone/Fax

Practice location:
  • Phone: 832-228-8483
  • Fax:
Mailing address:
  • Phone: 832-228-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1000163
License Number StateTX

VIII. Authorized Official

Name: STEPHEN OGAVU
Title or Position: OWNER/CEO
Credential:
Phone: 832-228-8483