Provider Demographics
NPI:1689659443
Name:ENTERPRISE AMBULANCE- HOUSTON, LTD
Entity Type:Organization
Organization Name:ENTERPRISE AMBULANCE- HOUSTON, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISIOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-337-8121
Mailing Address - Street 1:1232 FM 646 RD W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-3017
Mailing Address - Country:US
Mailing Address - Phone:281-534-5600
Mailing Address - Fax:281-337-8111
Practice Address - Street 1:1232 FM 646 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3017
Practice Address - Country:US
Practice Address - Phone:281-534-5600
Practice Address - Fax:281-337-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000679301Medicaid
TX000679301Medicaid