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NPI Code Detail

MEDICARE: TAMMY SHANAE BOULDIN E.M.T

MEDICARE:   TAMMY SHANAE BOULDIN  E.M.T
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
1171W00000XContractor150014TX

General Provider Information

NPI Number : 1558559625
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY SHANAE BOULDIN E.M.T
Provider Business Mailing Address
First Line : 5622 BRIDGE FOREST DR
Second Line :
City : HOUSTON
State : TX
Zip : 77088-2820
Country : US
Telephone Number : 713-378-1339
Fax Number : 281-272-2484
Provider Business Practice Location Address
First Line : 5622 BRIDGE FOREST DR
Second Line :
City : HOUSTON
State : TX
Zip : 77088-2820
Country : US
Telephone Number : 713-378-1339
Fax Number : 281-272-2484
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2007
Last Update Date : 10/13/2007

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Directions to “ TAMMY SHANAE BOULDIN E.M.T” Practice Location

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