=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952330102
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY EMS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2006
-----------------------------------------------------
Last Update Date | 10/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13940 BAMMEL NORTH HOUSTON RD STE 207
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77066-2948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-392-2920
-----------------------------------------------------
Fax | 281-880-9970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13940 BAMMEL NORTH HOUSTON RD STE 207
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77066-2948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-392-2920
-----------------------------------------------------
Fax | 281-880-9970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. RICHARTER DAMON JACKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-392-2920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------