MEDICARE: TRI STAR 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	1000115	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000115	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1164695508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI STAR EMS INC

Provider Business Mailing Address
First Line	:	9115 DRAGONWOOD TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-6575
Country	:	US
Telephone Number	:	713-503-6902
Fax Number	:	281-530-6015

Provider Business Practice Location Address
First Line	:	12542 ASHFORD RIV
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-5661
Country	:	US
Telephone Number	:	713-503-6902
Fax Number	:	281-530-6015

Authorized Official
Title or Position	:	OWNER
Name	:	KOFFI H AGAMAH
Credential	:
Telephone Number	:	713-503-6902

Provider Enumeration Date	:	04/07/2008
Last Update Date	:	04/07/2008

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Directions to “TRI STAR EMS INC ” Practice Location

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