Provider Demographics
NPI:1184757403
Name:CHAMPION EMS AMBULANCE SVC
Entity type:Organization
Organization Name:CHAMPION EMS AMBULANCE SVC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-283-9577
Mailing Address - Street 1:12521 FONDREN RD STE W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-5299
Mailing Address - Country:US
Mailing Address - Phone:713-283-9577
Mailing Address - Fax:713-283-8577
Practice Address - Street 1:12521 FONDREN RD STE W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-5299
Practice Address - Country:US
Practice Address - Phone:713-283-9577
Practice Address - Fax:713-283-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB416Medicare ID - Type UnspecifiedMEDICARE ID NUMBER