Provider Demographics
NPI:1356674154
Name:HEALTHSOURCE EMS LLC
Entity Type:Organization
Organization Name:HEALTHSOURCE EMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEMITAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-808-2628
Mailing Address - Street 1:20207 BROAD RUN LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-6496
Mailing Address - Country:US
Mailing Address - Phone:281-808-2628
Mailing Address - Fax:281-265-1040
Practice Address - Street 1:20207 BROAD RUN LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-6496
Practice Address - Country:US
Practice Address - Phone:281-808-2628
Practice Address - Fax:281-265-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10003153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000315OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES
TX1000315OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES