=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629298344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCY MEDICAL EMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8435 HEARTH DR #8
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-320-1958
-----------------------------------------------------
Fax | 713-692-8544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8435 HEARTH DR #8
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-320-1958
-----------------------------------------------------
Fax | 713-692-8544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MR. JOSEPH MICHAEL BARNES
-----------------------------------------------------
Credential | NREMT-P,
-----------------------------------------------------
Telephone | 713-320-1958
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | 800171
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------