1760400568 NPI number — MCLEAN EMS

Table of content: (NPI 1760400568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760400568 NPI number — MCLEAN EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLEAN EMS
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:
Provider Other Organization Name Type Code:
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:
1760400568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3005 S LAMAR BLVD
Provider Second Line Business Mailing Address:
SUITE D109-372
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-766-9471
Provider Business Mailing Address Fax Number:
512-275-3725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCLEAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-779-2872
Provider Business Practice Location Address Fax Number:
806-779-2777
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
STELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER BOOKKEEPER
Authorized Official Telephone Number:
806-779-2484

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  090004 , 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: TY4571 . This is a "HEALTHNET" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com