=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679585616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | START EMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14910 SHINGLE OAK DR
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77377-3853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-357-5056
-----------------------------------------------------
Fax | 281-351-1205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14910 SHINGLE OAK DR
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77377-3853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-357-5056
-----------------------------------------------------
Fax | 281-351-1205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MR. MARK LEE MILLER
-----------------------------------------------------
Credential | EMT-PARAMEDIC
-----------------------------------------------------
Telephone | 832-797-6379
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------