MEDICARE: PEDIATRIC TRANSPORT EMS LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance

General Provider Information

NPI Number	:	1053604603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC TRANSPORT EMS LLC.

Provider Business Mailing Address
First Line	:	1758 ALTA VISTA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-2502
Country	:	US
Telephone Number	:	713-926-7334
Fax Number	:

Provider Business Practice Location Address
First Line	:	1758 ALTA VISTA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-2502
Country	:	US
Telephone Number	:	713-926-7334
Fax Number	:	713-947-6834

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ADRIAN RIVERA
Credential	:
Telephone Number	:	713-926-7334

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	05/16/2011

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