Provider Demographics
NPI:1093974545
Name:MEDSOURCE EMS INC.
Entity Type:Organization
Organization Name:MEDSOURCE EMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:ABIOLA
Authorized Official - Last Name:FAGBEYIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-270-0700
Mailing Address - Street 1:2626 S. LOOP WEST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5613
Mailing Address - Country:US
Mailing Address - Phone:713-669-1090
Mailing Address - Fax:713-669-1091
Practice Address - Street 1:10101 HARWIN DR
Practice Address - Street 2:SUITE 324
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1687
Practice Address - Country:US
Practice Address - Phone:713-270-0700
Practice Address - Fax:713-270-8331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10001423416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000142OtherTEXAS DEPARTMENT OF HEALTH
TX1000142OtherTEXAS DEPARTMENT OF HEALTH