Provider Demographics
NPI:1275692287
Name:SPACE CITY EMS LLC
Entity Type:Organization
Organization Name:SPACE CITY EMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-944-4667
Mailing Address - Street 1:7999 HANSEN RD STE 308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-3450
Mailing Address - Country:US
Mailing Address - Phone:713-944-4667
Mailing Address - Fax:713-946-4888
Practice Address - Street 1:7999 HANSEN RD STE 308
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-3450
Practice Address - Country:US
Practice Address - Phone:713-944-4667
Practice Address - Fax:713-946-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800204341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX800204OtherPROVIDER STATE LICENSE