MEDICARE: ETHRIDGE MEDICAL SERVICES

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	101502	TX

General Provider Information

NPI Number	:	1801888599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETHRIDGE MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	514 DEEPGROVE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-4012
Country	:	US
Telephone Number	:	281-445-7616
Fax Number	:	713-290-8417

Provider Business Practice Location Address
First Line	:	514 DEEPGROVE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-4012
Country	:	US
Telephone Number	:	281-445-7616
Fax Number	:	713-290-8417

Authorized Official
Title or Position	:	OWNER
Name	:	MARTHA JEAN ETHRIDGE
Credential	:
Telephone Number	:	281-445-7616

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	08/21/2007

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Directions to “ETHRIDGE MEDICAL SERVICES ” Practice Location

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