1205859998 NPI number — LONESTAR EMERGENCY MEDICAL SERVICES

Table of content: (NPI 1205859998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205859998 NPI number — LONESTAR EMERGENCY MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONESTAR EMERGENCY MEDICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LONE STAR EMS, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205859998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77351-1799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-327-9024
Provider Business Mailing Address Fax Number:
936-327-8367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 N WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77351-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-327-9024
Provider Business Practice Location Address Fax Number:
936-327-8367
Provider Enumeration Date:
07/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLLIER
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
DALTON
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
936-327-9024

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  300653 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 162209401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00106253 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AMB673 . This is a "BC/BS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".