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General NPI Number Information
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NPI Number | 1578584124
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Entity Type | Organization
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Legal Business Name | PATRIOT EMS GROUP, INC.
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 12411 ANN LN
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City | HOUSTON
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State | TX
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Zip | 77064-1205
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Country | US
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Telephone | 281-897-8918
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Fax | 281-897-8927
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Provider Business Mailing Address
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Address Line | PO BOX 691245
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City | HOUSTON
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State | TX
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Zip | 77269-1245
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Country | US
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Telephone | 281-897-8918
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Fax | 281-897-8927
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | SHANNON WADE
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Credential | PARAMEDIC
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Telephone | 281-897-8918
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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 | 101503
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License Number State | TX
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