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General NPI Number Information
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NPI Number | 1174794119
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Entity Type | Individual
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Provider Name | RILEY WILSON
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Gender | Male
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 23552 FM 1314 RD
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City | PORTER
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State | TX
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Zip | 77365-3468
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Country | US
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Telephone | 713-974-3131
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Fax | 713-974-3162
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Provider Business Mailing Address
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Address Line | 9639 ROARKS PSGE
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City | MISSOURI CITY
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State | TX
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Zip | 77459-6232
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Country | US
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Telephone | 713-884-5545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 800180
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License Number State | TX
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