Provider Demographics
NPI:1477543635
Name:PHOENIX EMERGENCY SERVICE, INC.
Entity type:Organization
Organization Name:PHOENIX EMERGENCY SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:281-392-4251
Mailing Address - Street 1:761 CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8252
Mailing Address - Country:US
Mailing Address - Phone:281-392-4251
Mailing Address - Fax:281-392-8177
Practice Address - Street 1:761 CAROLINA ST
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8252
Practice Address - Country:US
Practice Address - Phone:281-392-4251
Practice Address - Fax:281-392-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300260146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX300260OtherSTATE PROVIDER #
TXAOAMB0934Medicaid
TX300260OtherSTATE PROVIDER #