MEDICARE: MEDLINE EMS LLC

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	1000652	TX

General Provider Information

NPI Number	:	1730476482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDLINE EMS LLC

Provider Business Mailing Address
First Line	:	9119 HIGHWAY 6
Second Line	:	SUITE 230-240
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4876
Country	:	US
Telephone Number	:	281-972-2038
Fax Number	:	281-781-2555

Provider Business Practice Location Address
First Line	:	4542 LONG CREEK DR
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-6064
Country	:	US
Telephone Number	:	281-972-2038
Fax Number	:	281-781-2555

Authorized Official
Title or Position	:	OWNER
Name	:	NDUKA K UKAH
Credential	:
Telephone Number	:	281-972-2038

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	07/07/2011

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Directions to “MEDLINE EMS LLC ” Practice Location

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