MEDICARE: PROVIDIAN EMS

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	1000147	TX

General Provider Information

NPI Number	:	1720234966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDIAN EMS

Provider Business Mailing Address
First Line	:	6820 LARKWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-3520
Country	:	US
Telephone Number	:	832-640-8972
Fax Number	:

Provider Business Practice Location Address
First Line	:	6820 LARKWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-3520
Country	:	US
Telephone Number	:	832-640-8972
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NASSAR BENCHAITA
Credential	:
Telephone Number	:	832-640-8972

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	06/22/2009

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Directions to “PROVIDIAN EMS ” Practice Location

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