Provider Demographics
NPI:1558937490
Name:MED-TRANSPORT A&E
Entity Type:Organization
Organization Name:MED-TRANSPORT A&E
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AFIYFA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-801-0401
Mailing Address - Street 1:10700 FONDREN RD APT 224
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5688
Mailing Address - Country:US
Mailing Address - Phone:713-331-4328
Mailing Address - Fax:
Practice Address - Street 1:10700 FONDREN RD APT 224
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-5688
Practice Address - Country:US
Practice Address - Phone:713-331-4328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17879792Medicaid