Provider Demographics
NPI:1922390525
Name:MIRACLE EMS INC
Entity Type:Organization
Organization Name:MIRACLE EMS INC
Other - Org Name:VILLAWOOD MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:OKONMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-201-5538
Mailing Address - Street 1:10100 BELKNAP RD
Mailing Address - Street 2:SUITE A7
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-1124
Mailing Address - Country:US
Mailing Address - Phone:281-201-5538
Mailing Address - Fax:281-201-5539
Practice Address - Street 1:10100 BELKNAP RD
Practice Address - Street 2:SUITE A7
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-1124
Practice Address - Country:US
Practice Address - Phone:281-201-5538
Practice Address - Fax:281-201-5539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10006223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000622OtherTEXAS DEPARTMENT OF STATE HEALTH SERVI CES