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General NPI Number Information
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NPI Number | 1124326095
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Entity Type | Organization
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Legal Business Name | MAGNOLIA EMS, LLC
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 6550 MAPLERIDGE ST STE 119
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City | HOUSTON
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State | TX
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Zip | 77081-4629
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Country | US
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Telephone | 713-660-0558
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Fax | 713-660-0935
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Provider Business Mailing Address
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Address Line | 6550 MAPLERIDGE ST STE 119
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City | HOUSTON
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State | TX
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Zip | 77081-4629
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Country | US
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Telephone | 713-660-0558
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Fax | 713-660-0935
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL J CAVAZOS
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Credential |
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Telephone | 713-660-0558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 1000570
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License Number State | TX
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