MEDICARE: PENINSULA EMERGENCY MEDICAL SERVICES, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000760	OTHER	TX	TDH LICENSE #

General Provider Information

NPI Number	:	1164731808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENINSULA EMERGENCY MEDICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 691363
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77269-1363
Country	:	US
Telephone Number	:	281-397-0397
Fax Number	:	281-397-6934

Provider Business Practice Location Address
First Line	:	2041 7TH STREET
Second Line	:
City	:	HIGH ISLAND
State	:	TX
Zip	:	77623
Country	:	US
Telephone Number	:	409-286-5811
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	KAREN P LAAKE
Credential	:
Telephone Number	:	281-397-0397

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	03/23/2015

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