MEDICARE: SPRINGBOARD EMS 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	1000681	TX

General Provider Information

NPI Number	:	1366726192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGBOARD EMS LLC

Provider Business Mailing Address
First Line	:	8633 W AIRPORT BLVD
Second Line	:	1022
City	:	HOUSTON
State	:	TX
Zip	:	77071-2479
Country	:	US
Telephone Number	:	832-407-8145
Fax Number	:	713-981-6554

Provider Business Practice Location Address
First Line	:	8633 W AIRPORT BLVD
Second Line	:	1022
City	:	HOUSTON
State	:	TX
Zip	:	77071-2479
Country	:	US
Telephone Number	:	832-407-8145
Fax Number	:	713-981-6554

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES OKEAGU
Credential	:
Telephone Number	:	832-407-8145

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	09/28/2011

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Directions to “SPRINGBOARD EMS LLC ” Practice Location

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