Provider Demographics
NPI:1699855114
Name:LIFEWAY EMS INC
Entity type:Organization
Organization Name:LIFEWAY EMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-728-5656
Mailing Address - Street 1:2656 SOUTH LOOP W
Mailing Address - Street 2:506
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2664
Mailing Address - Country:US
Mailing Address - Phone:713-728-5656
Mailing Address - Fax:713-669-1091
Practice Address - Street 1:2656 SOUTH LOOP W
Practice Address - Street 2:506
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2664
Practice Address - Country:US
Practice Address - Phone:713-728-5656
Practice Address - Fax:713-669-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101315341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162585701Medicaid
TXAMB757OtherBLUE CROSS BLUE SHIELD
TXAMB342Medicare PIN