Provider Demographics
NPI:1467495739
Name:WILLOWBROOK EMS GROUP INC
Entity Type:Organization
Organization Name:WILLOWBROOK EMS GROUP INC
Other - Org Name:WILLOWBROOK EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-469-1551
Mailing Address - Street 1:33 LYERLY STREET
Mailing Address - Street 2:SUITE A2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022
Mailing Address - Country:US
Mailing Address - Phone:281-469-1551
Mailing Address - Fax:888-887-4985
Practice Address - Street 1:33 LYERLY STREET
Practice Address - Street 2:SUITE A2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022
Practice Address - Country:US
Practice Address - Phone:281-469-1551
Practice Address - Fax:888-887-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8000353416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB716OtherBCBS
TXAMB1244Medicare PIN
TXAMB716OtherBCBS