MEDICARE: TRINITY 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	341600000X	Ambulance

General Provider Information

NPI Number	:	1952330102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY EMS, LLC

Provider Business Mailing Address
First Line	:	13940 BAMMEL NORTH HOUSTON RD STE 207
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-2948
Country	:	US
Telephone Number	:	713-392-2920
Fax Number	:	281-880-9970

Provider Business Practice Location Address
First Line	:	13940 BAMMEL NORTH HOUSTON RD STE 207
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-2948
Country	:	US
Telephone Number	:	713-392-2920
Fax Number	:	281-880-9970

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. RICHARTER DAMON JACKSON
Credential	:
Telephone Number	:	713-392-2920

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	10/21/2008

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