MEDICARE: SPACE CITY MEDICAB

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	343800000X	Secured Medical Transport (VAN)		TX

General Provider Information

NPI Number	:	1356717185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPACE CITY MEDICAB

Provider Business Mailing Address
First Line	:	P.O. BOX 58624
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77258-8801
Country	:	US
Telephone Number	:	210-833-4094
Fax Number	:

Provider Business Practice Location Address
First Line	:	18214 UPPER BAY RD
Second Line	:	P.O. 58624
City	:	HOUSTON
State	:	TX
Zip	:	77258-1874
Country	:	US
Telephone Number	:	210-833-4094
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD L. DRUMMER
Credential	:
Telephone Number	:	210-833-4094

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

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Directions to “SPACE CITY MEDICAB ” Practice Location

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