Organization
PROVIDENCE EMS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONNIE HAYDEN (OWNER)
(281) 498-2959
Entity
Organization
Contact information
Practice address
12807 LEADER ST, HOUSTON, TX 77072-2121
(281) 498-2959
(713) 669-1091
Mailing address
12807 LEADER ST, HOUSTON, TX 77072-2121
(281) 498-2959
(713) 669-1091
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
800100
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AMB835
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/03/2006
Last updated
10/15/2007
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