Provider Demographics
NPI:1073823985
Name:GENESIS AMBULANCE INC
Entity Type:Organization
Organization Name:GENESIS AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLA
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-714-7220
Mailing Address - Street 1:7343 ATHLONE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-7422
Mailing Address - Country:US
Mailing Address - Phone:281-714-7220
Mailing Address - Fax:281-931-5073
Practice Address - Street 1:7343 ATHLONE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-7422
Practice Address - Country:US
Practice Address - Phone:281-714-7220
Practice Address - Fax:281-931-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000475341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance