Provider Demographics
NPI:1205818150
Name:SOUTHEAST
Entity Type:Organization
Organization Name:SOUTHEAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-771-5003
Mailing Address - Street 1:8300 BISSONNET ST
Mailing Address - Street 2:STE 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3900
Mailing Address - Country:US
Mailing Address - Phone:713-773-4355
Mailing Address - Fax:713-773-4363
Practice Address - Street 1:8303 SW FWY
Practice Address - Street 2:STE 320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1600
Practice Address - Country:US
Practice Address - Phone:713-771-5003
Practice Address - Fax:713-771-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101263341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB188Medicare ID - Type Unspecified