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General NPI Number Information
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NPI Number | 1609751056
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Entity Type | Organization
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Legal Business Name | LAKESHORE MEDICAL TRANSPORT
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 12808 W AIRPORT BLVD STE 325C
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City | SUGAR LAND
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State | TX
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Zip | 77478-6227
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Country | US
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Telephone | 713-364-6848
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Fax |
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Provider Business Mailing Address
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Address Line | 12808 W AIRPORT BLVD STE 325C
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City | SUGAR LAND
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State | TX
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Zip | 77478-6227
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Country | US
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Telephone | 713-364-6848
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BUBACARR SAMATEH
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Credential |
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Telephone | 503-267-8905
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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 |
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License Number State |
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