MEDICARE: LIFEWAY EMS 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	341600000X	Ambulance	101315	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
2	AMB757	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1699855114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEWAY EMS INC

Provider Business Mailing Address
First Line	:	2656 SOUTH LOOP W
Second Line	:	506
City	:	HOUSTON
State	:	TX
Zip	:	77054-2664
Country	:	US
Telephone Number	:	713-728-5656
Fax Number	:	713-669-1091

Provider Business Practice Location Address
First Line	:	2656 SOUTH LOOP W
Second Line	:	506
City	:	HOUSTON
State	:	TX
Zip	:	77054-2664
Country	:	US
Telephone Number	:	713-728-5656
Fax Number	:	713-669-1091

Authorized Official
Title or Position	:	OWNER
Name	:	ENE HOGAN
Credential	:
Telephone Number	:	713-728-5656

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/22/2008

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Directions to “LIFEWAY EMS INC ” Practice Location

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