MEDICARE: EBONG O. ETUK

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	101413	TX

General Provider Information

NPI Number	:	1427144351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EBONG O. ETUK

Provider Business Mailing Address
First Line	:	8700 COMMERCE PARK DR
Second Line	:	124
City	:	HOUSTON
State	:	TX
Zip	:	77036-7497
Country	:	US
Telephone Number	:	713-981-6455
Fax Number	:	713-669-1091

Provider Business Practice Location Address
First Line	:	8700 COMMERCE PARK DR
Second Line	:	124
City	:	HOUSTON
State	:	TX
Zip	:	77036-7497
Country	:	US
Telephone Number	:	713-981-6455
Fax Number	:	713-669-1091

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES ETUK
Credential	:
Telephone Number	:	713-981-6455

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	10/10/2007

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