Provider Demographics
NPI:1487649406
Name:MEDICAL CENTER EMERGENCY SERVICE
Entity Type:Organization
Organization Name:MEDICAL CENTER EMERGENCY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-450-1000
Mailing Address - Street 1:PO BOX 9827
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77213-0827
Mailing Address - Country:US
Mailing Address - Phone:713-450-1000
Mailing Address - Fax:713-450-4141
Practice Address - Street 1:8191 SOUTHWEST FWY
Practice Address - Street 2:203
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1709
Practice Address - Country:US
Practice Address - Phone:713-450-1000
Practice Address - Fax:713-450-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB353Medicaid
TXAMB353Medicaid