=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043295249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAREGIVER EMS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8922 FREY RD SUITE C1
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77034-3564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-910-2278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 752473
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77275-2473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-910-2273
-----------------------------------------------------
Fax | 713-910-0300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ERROLL JONATHAN ELLIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-292-8505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 101320
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------