Provider Demographics
NPI:1932561248
Name:HEALTHSOURCE MEDICAL RESPONSE, LLC
Entity Type:Organization
Organization Name:HEALTHSOURCE MEDICAL RESPONSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NDIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-880-3305
Mailing Address - Street 1:1205 N MEYER ST
Mailing Address - Street 2:STE 3
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-1693
Mailing Address - Country:US
Mailing Address - Phone:713-774-0565
Mailing Address - Fax:
Practice Address - Street 1:1205 N MEYER ST
Practice Address - Street 2:STE 3
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-1693
Practice Address - Country:US
Practice Address - Phone:713-774-0565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance