Provider Demographics
NPI:1437128543
Name:PHOENIX EMS INC
Entity Type:Organization
Organization Name:PHOENIX EMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-392-6743
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:BROOKSHIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77423-0879
Mailing Address - Country:US
Mailing Address - Phone:281-392-6743
Mailing Address - Fax:281-392-7803
Practice Address - Street 1:761 CAROLINA ST
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-392-6743
Practice Address - Fax:281-392-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000732001Medicaid
LA1635804Medicaid
C13465Medicare UPIN
LA1635804Medicaid
TX000732001Medicaid