Provider Demographics
NPI:1649400151
Name:VIC EMS LLC
Entity Type:Organization
Organization Name:VIC EMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OHANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-771-5088
Mailing Address - Street 1:8700 COMMERCE PARK DR
Mailing Address - Street 2:228G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7497
Mailing Address - Country:US
Mailing Address - Phone:713-771-5088
Mailing Address - Fax:713-771-5096
Practice Address - Street 1:8700 COMMERCE PARK DR
Practice Address - Street 2:228G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7497
Practice Address - Country:US
Practice Address - Phone:713-771-5088
Practice Address - Fax:713-771-5096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416S0300XTransportation ServicesAmbulanceWater Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000276OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES
TX205707701Medicaid
TX1000276OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES