Provider Demographics
NPI:1578584124
Name:PATRIOT EMS GROUP, INC.
Entity Type:Organization
Organization Name:PATRIOT EMS GROUP, INC.
Other - Org Name:PATRIOT EMS GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:281-897-8918
Mailing Address - Street 1:PO BOX 691245
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-1245
Mailing Address - Country:US
Mailing Address - Phone:281-897-8918
Mailing Address - Fax:281-897-8927
Practice Address - Street 1:12411 ANN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1205
Practice Address - Country:US
Practice Address - Phone:281-897-8918
Practice Address - Fax:281-897-8927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101503341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB756OtherBC/BS OF TEXAS
TXP00249093OtherRR MEDICARE
TX180243101Medicaid
P00249093OtherRAILROAD MEDICARE
P00249093OtherRAILROAD MEDICARE
P00249093OtherRAILROAD MEDICARE