Provider Demographics
NPI:1730460569
Name:MED-PORT MEDICAL TRANSPORTATION SERVICES
Entity Type:Organization
Organization Name:MED-PORT MEDICAL TRANSPORTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:EYVETTE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-276-2104
Mailing Address - Street 1:8787 S GESSNER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2915
Mailing Address - Country:US
Mailing Address - Phone:713-777-0200
Mailing Address - Fax:713-271-7802
Practice Address - Street 1:8787 S GESSNER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2915
Practice Address - Country:US
Practice Address - Phone:713-777-0200
Practice Address - Fax:713-271-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)