Organization
MEDSOURCE EMS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLA ABIOLA FAGBEYIRO (CEO)
(713) 270-0700
Entity
Organization
Contact information
Practice address
10101 HARWIN DR, SUITE 324, HOUSTON, TX 77036-1687
(713) 270-0700
(713) 270-8331
Mailing address
2626 S. LOOP WEST, SUITE 340, HOUSTON, TX 77054-5613
(713) 669-1090
(713) 669-1091
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1000142
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000142
TEXAS DEPARTMENT OF HEALTH
TX
Enumeration date
06/09/2008
Last updated
10/15/2008
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