Provider Demographics
NPI:1588607238
Name:CYPRESS CREEK EMERGENCY MEDICAL SERVICES ASSOCIATION
Entity Type:Organization
Organization Name:CYPRESS CREEK EMERGENCY MEDICAL SERVICES ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WRENDELL
Authorized Official - Middle Name:RE
Authorized Official - Last Name:NEALY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:281-378-0800
Mailing Address - Street 1:PO BOX 650998 HOU1097
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0998
Mailing Address - Country:US
Mailing Address - Phone:281-378-0800
Mailing Address - Fax:281-655-0414
Practice Address - Street 1:7111 FIVE FORKS DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4101
Practice Address - Country:US
Practice Address - Phone:281-378-0800
Practice Address - Fax:281-655-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010913416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000057201Medicaid
TXAMB001OtherBLUE CROSS AND BLUE SHIELD OF TEXAS
TXAMB001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER