Provider Demographics
NPI:1285468553
Name:AVENGING ANGEL MEDICAL TRANSPORTS LLC
Entity type:Organization
Organization Name:AVENGING ANGEL MEDICAL TRANSPORTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:W
Authorized Official - Last Name:TILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-347-0306
Mailing Address - Street 1:3050 POST OAK BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6512
Mailing Address - Country:US
Mailing Address - Phone:713-347-3060
Mailing Address - Fax:
Practice Address - Street 1:3050 POST OAK BLVD STE 510
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6512
Practice Address - Country:US
Practice Address - Phone:713-347-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)