MEDICARE: ATLANTIS AMBULANCE SERVICE 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	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1255731592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIS AMBULANCE SERVICE LLC

Provider Business Mailing Address
First Line	:	5645 HILLCROFT ST
Second Line	:	SUITE 607
City	:	HOUSTON
State	:	TX
Zip	:	77036-2296
Country	:	US
Telephone Number	:	281-995-4854
Fax Number	:

Provider Business Practice Location Address
First Line	:	5645 HILLCROFT ST
Second Line	:	SUITE 607
City	:	HOUSTON
State	:	TX
Zip	:	77036-2296
Country	:	US
Telephone Number	:	281-995-4854
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTOINE JOSEPH
Credential	:
Telephone Number	:	832-209-9207

Provider Enumeration Date	:	08/22/2014
Last Update Date	:	09/02/2014

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