MEDICARE: WILLOWBROOK EMS GROUP 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	800035	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AMB716	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1467495739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOWBROOK EMS GROUP INC

Provider Business Mailing Address
First Line	:	519 N SAM HOUSTON PKWY E STE 430
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-4136
Country	:	US
Telephone Number	:	281-469-1551
Fax Number	:	888-887-4985

Provider Business Practice Location Address
First Line	:	519 N SAM HOUSTON PKWY E STE 430
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-4136
Country	:	US
Telephone Number	:	281-469-1551
Fax Number	:	888-887-4985

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CLERCY GAINES
Credential	:
Telephone Number	:	281-469-1551

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/04/2024

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