=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760604649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VENTURA MEDICAL SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 11/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 S ROBB ST
-----------------------------------------------------
City | TRINITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75862-7647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-228-3478
-----------------------------------------------------
Fax | 936-755-1037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5907 THEALL RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77066-2341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-228-3478
-----------------------------------------------------
Fax | 936-755-1037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | KEITH R SHELLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 936-228-3478
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------