Provider Demographics
NPI:1982996476
Name:ENA DENISE COWART KARLSTEN OTIS
Entity Type:Organization
Organization Name:ENA DENISE COWART KARLSTEN OTIS
Other - Org Name:PREMIER EMS SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNECKE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:832-603-4200
Mailing Address - Street 1:6040 WESTPARK DR
Mailing Address - Street 2:UNIT # E004
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7533
Mailing Address - Country:US
Mailing Address - Phone:832-603-4200
Mailing Address - Fax:
Practice Address - Street 1:6040 WESTPARK DR
Practice Address - Street 2:UNIT # E004
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7533
Practice Address - Country:US
Practice Address - Phone:832-603-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10006003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport