Provider Demographics
NPI:1013985589
Name:NORTH CHANNEL EMERGENCY MEDICAL SERVICES ASSOCIATION
Entity Type:Organization
Organization Name:NORTH CHANNEL EMERGENCY MEDICAL SERVICES ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-397-0397
Mailing Address - Street 1:PO BOX 691363
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-1363
Mailing Address - Country:US
Mailing Address - Phone:281-397-0397
Mailing Address - Fax:281-397-6934
Practice Address - Street 1:332 FREEPORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-2311
Practice Address - Country:US
Practice Address - Phone:713-637-0900
Practice Address - Fax:713-637-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1635782Medicaid
TX000318801Medicaid
G18595Medicare UPIN
LA1635782Medicaid
TX000318801Medicaid