Provider Demographics
NPI:1770966814
Name:BLACK, TONEE
Entity type:Individual
Prefix:
First Name:TONEE
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 SOUTHWEST FWY
Mailing Address - Street 2:400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7312
Mailing Address - Country:US
Mailing Address - Phone:832-919-9769
Mailing Address - Fax:
Practice Address - Street 1:4151 SOUTHWEST FWY
Practice Address - Street 2:400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7312
Practice Address - Country:US
Practice Address - Phone:832-919-9769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01691830343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)