MEDICARE: MOLENTIUM EMS, 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	1001021	OTHER	TX	TEXAS DEPARTMENT OF STATE HEALTH SERVICES

General Provider Information

NPI Number	:	1376169870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLENTIUM EMS, INC.

Provider Business Mailing Address
First Line	:	2024 NAOMI ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-3821
Country	:	US
Telephone Number	:	713-485-5463
Fax Number	:	713-485-5473

Provider Business Practice Location Address
First Line	:	2024 NAOMI ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-3821
Country	:	US
Telephone Number	:	713-485-5463
Fax Number	:	713-485-5473

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MONIQUE CHARLES
Credential	:
Telephone Number	:	979-618-6152

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	06/19/2020

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