Provider Demographics
NPI:1205137486
Name:GENESIS AMBULANCE INCC
Entity type:Organization
Organization Name:GENESIS AMBULANCE INCC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLA
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-714-7220
Mailing Address - Street 1:7343 ATHLONE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-7422
Mailing Address - Country:US
Mailing Address - Phone:281-714-7220
Mailing Address - Fax:281-931-5073
Practice Address - Street 1:7343 ATHLONE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-7422
Practice Address - Country:US
Practice Address - Phone:281-714-7220
Practice Address - Fax:281-931-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10004753416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport