MEDICARE: REVOLUTION EMS INC

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	3416L0300X	Land Ambulance	1000404	TX

General Provider Information

NPI Number	:	1114247384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVOLUTION EMS INC

Provider Business Mailing Address
First Line	:	3916 W 34TH ST
Second Line	:	STE K
City	:	HOUSTON
State	:	TX
Zip	:	77092-6425
Country	:	US
Telephone Number	:	832-658-6805
Fax Number	:	713-290-9047

Provider Business Practice Location Address
First Line	:	3916 W 34TH ST
Second Line	:	STE K
City	:	HOUSTON
State	:	TX
Zip	:	77092-6425
Country	:	US
Telephone Number	:	832-658-6805
Fax Number	:	713-290-9047

Authorized Official
Title or Position	:	OWNER
Name	:	ANDRES GARCIA JR.
Credential	:
Telephone Number	:	832-658-6805

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	06/10/2010

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