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General NPI Number Information
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NPI Number | 1356616387
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Entity Type | Organization
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Legal Business Name | BRAI MEDICAL TRANSPORTATION
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 6316 DRYAD DR,
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City | HOUSTON
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State | TX
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Zip | 77035
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Country | US
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Telephone | 832-794-6297
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Fax |
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Provider Business Mailing Address
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Address Line | 6316 DRYAD DR
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City | HOUSTON
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State | TX
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Zip | 77035-6605
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Country | US
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Telephone | 832-794-6297
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEFFREY IMOAGENE AYONOTE
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Credential |
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Telephone | 832-794-6297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 801546132
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License Number State | TX
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