MEDICARE: ST. BONIFACE 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	3416L0300X	Land Ambulance	800160	TX

General Provider Information

NPI Number	:	1902839145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. BONIFACE EMS, INC.

Provider Business Mailing Address
First Line	:	6911 MAYARD RD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77041-2622
Country	:	US
Telephone Number	:	713-896-6777
Fax Number	:	713-896-6779

Provider Business Practice Location Address
First Line	:	6911 MAYARD RD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77041-2622
Country	:	US
Telephone Number	:	713-896-6777
Fax Number	:	713-896-6779

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. KATHY M PRICHARD
Credential	:	RN, OCN
Telephone Number	:	713-896-6777

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	09/12/2007

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