MEDICARE: SUNRISE AMBULANCE SERVICE

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	1000478	TX

General Provider Information

NPI Number	:	1538474077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 710419
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77271-0419
Country	:	US
Telephone Number	:	832-723-5269
Fax Number	:	281-674-8120

Provider Business Practice Location Address
First Line	:	13526 LA CONCHA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5125
Country	:	US
Telephone Number	:	832-723-5269
Fax Number	:	281-674-8120

Authorized Official
Title or Position	:	OWNER
Name	:	CHIEDOZIE J. AGBOGU
Credential	:
Telephone Number	:	832-723-5269

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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Directions to “SUNRISE AMBULANCE SERVICE ” Practice Location

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