=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023328960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CLASS ANUBLANCE SERVICE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2010
-----------------------------------------------------
Last Update Date | 10/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9001 AIRPORT BLVD SUITE 508
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77061-3474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-896-4325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9001 AIRPORT BLVD SUITE 508
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77061-3474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-896-4325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GEORGE W GARDNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-896-4325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 1000517
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------