MEDICARE: ENTERPRISE AMBULANCE- HOUSTON, LTD

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	30015	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689659443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTERPRISE AMBULANCE- HOUSTON, LTD

Provider Business Mailing Address
First Line	:	1232 FM 646 RD W
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-3017
Country	:	US
Telephone Number	:	281-534-5600
Fax Number	:	281-337-8111

Provider Business Practice Location Address
First Line	:	1232 FM 646 RD W
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-3017
Country	:	US
Telephone Number	:	281-534-5600
Fax Number	:	281-337-8111

Authorized Official
Title or Position	:	BILLING SUPERVISIOR
Name	:	MS. PAM WAGNER
Credential	:
Telephone Number	:	281-337-8121

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	04/06/2009

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