=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356919641
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLENNIUM EMS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2021
-----------------------------------------------------
Last Update Date | 06/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 RICHEY RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090-5707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-349-3390
-----------------------------------------------------
Fax | 713-583-9777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8765 SPRING CYPRESS RD STE L336
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-3194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-349-3390
-----------------------------------------------------
Fax | 713-583-9777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. TERRANCE MOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-349-3390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------