Provider Demographics
NPI:1104652023
Name:5000WATSON LLC
Entity type:Organization
Organization Name:5000WATSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KANTERIA
Authorized Official - Middle Name:RONIQUE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-703-2997
Mailing Address - Street 1:14695 BRIAR FOREST DR APT 8107
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2717
Mailing Address - Country:US
Mailing Address - Phone:817-703-2997
Mailing Address - Fax:
Practice Address - Street 1:14695 BRIAR FOREST DR APT 8107
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-2717
Practice Address - Country:US
Practice Address - Phone:817-703-2997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)