=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134262066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AAE&E REGIONAL SELECT, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18514 HEADLAND DR
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433-1192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-330-9914
-----------------------------------------------------
Fax | 866-835-6560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2310
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77487-2310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-330-9914
-----------------------------------------------------
Fax | 866-835-6560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS DIRECTOR
-----------------------------------------------------
Name | MR. NATHAN H EYE
-----------------------------------------------------
Credential | LIC-P
-----------------------------------------------------
Telephone | 281-330-9914
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 800222
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------