MEDICARE: SOUTHEAST

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	101263	TX

General Provider Information

NPI Number	:	1205818150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST

Provider Business Mailing Address
First Line	:	8300 BISSONNET ST
Second Line	:	STE 205
City	:	HOUSTON
State	:	TX
Zip	:	77074-3900
Country	:	US
Telephone Number	:	713-773-4355
Fax Number	:	713-773-4363

Provider Business Practice Location Address
First Line	:	8303 SW FWY
Second Line	:	STE 320
City	:	HOUSTON
State	:	TX
Zip	:	77074-1600
Country	:	US
Telephone Number	:	713-771-5003
Fax Number	:	713-771-4144

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JOE OGBEBOR
Credential	:
Telephone Number	:	713-771-5003

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/22/2020

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Directions to “SOUTHEAST ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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