Provider Demographics
NPI:1790042463
Name:SAMSON EDIAE
Entity Type:Organization
Organization Name:SAMSON EDIAE
Other - Org Name:LUCKY EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:EDIAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-271-2066
Mailing Address - Street 1:9630 CLAREWOOD DR
Mailing Address - Street 2:STE B6
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3512
Mailing Address - Country:US
Mailing Address - Phone:713-271-2066
Mailing Address - Fax:713-271-2088
Practice Address - Street 1:9630 CLAREWOOD DR
Practice Address - Street 2:STE B6
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3512
Practice Address - Country:US
Practice Address - Phone:713-271-2066
Practice Address - Fax:713-271-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10007443416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport