Provider Demographics
NPI:1649419284
Name:LAKEWOOD TRANSPORT SERVICE
Entity Type:Organization
Organization Name:LAKEWOOD TRANSPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AVERIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-704-4050
Mailing Address - Street 1:3525 S SAM HOUSTON PKWY E
Mailing Address - Street 2:723
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-6803
Mailing Address - Country:US
Mailing Address - Phone:832-704-4050
Mailing Address - Fax:713-668-2273
Practice Address - Street 1:3525 S SAM HOUSTON PKWY E
Practice Address - Street 2:723
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-6803
Practice Address - Country:US
Practice Address - Phone:832-704-4050
Practice Address - Fax:713-668-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport