Provider Demographics
NPI:1144405358
Name:LEGEND EMS INC.
Entity Type:Organization
Organization Name:LEGEND EMS INC.
Other - Org Name:LEGEND EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:EZIUKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-573-1933
Mailing Address - Street 1:2626 S LOOP W
Mailing Address - Street 2:340
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2654
Mailing Address - Country:US
Mailing Address - Phone:832-573-1933
Mailing Address - Fax:713-669-1091
Practice Address - Street 1:10909 SABO ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6202
Practice Address - Country:US
Practice Address - Phone:832-573-1933
Practice Address - Fax:713-400-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000089341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB647Medicare PIN