MEDICARE: CITY OF NASSAU BAY

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	101046	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590012635	OTHER	TX	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101046	OTHER	TX	DSHS LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	528275	OTHER	TX	BC/BS OF TEXAS

General Provider Information

NPI Number	:	1508887258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF NASSAU BAY

Provider Business Mailing Address
First Line	:	1800 SPACE PARK DRIVE
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77058
Country	:	US
Telephone Number	:	281-335-5380
Fax Number	:	281-333-2301

Provider Business Practice Location Address
First Line	:	18100 UPPER BAY RD
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77058-3548
Country	:	US
Telephone Number	:	281-335-5380
Fax Number	:	281-333-2301

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	CSILLA STILES
Credential	:
Telephone Number	:	281-336-6284

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	10/24/2014

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Directions to “CITY OF NASSAU BAY ” Practice Location

Language	Start Address	Practice Location

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