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General NPI Number Information
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NPI Number | 1720234966
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Entity Type | Organization
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Legal Business Name | PROVIDIAN EMS
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 6820 LARKWOOD DR
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City | HOUSTON
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State | TX
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Zip | 77074-3520
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Country | US
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Telephone | 832-640-8972
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Fax |
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Provider Business Mailing Address
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Address Line | 6820 LARKWOOD DR
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City | HOUSTON
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State | TX
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Zip | 77074-3520
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Country | US
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Telephone | 832-640-8972
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NASSAR BENCHAITA
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Credential |
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Telephone | 832-640-8972
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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 | 1000147
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License Number State | TX
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