Provider Demographics
NPI:1184818247
Name:SAFEWAY SHUTTLE SERVICE
Entity Type:Organization
Organization Name:SAFEWAY SHUTTLE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:M,ARCUS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-960-2088
Mailing Address - Street 1:11950 E MARSHAM CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-4431
Mailing Address - Country:US
Mailing Address - Phone:713-960-2088
Mailing Address - Fax:
Practice Address - Street 1:11950 E MARSHAM CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-4431
Practice Address - Country:US
Practice Address - Phone:713-960-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)