1376576553 NPI number — REDDS AMBULANCE SERVICE INC

Table of content: (NPI 1376576553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376576553 NPI number — REDDS AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDDS AMBULANCE SERVICE INC
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:
REDD'S AMBULANCE SERVICE
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:
1376576553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77720-3120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-899-2644
Provider Business Mailing Address Fax Number:
409-899-2645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5655 EASTEX FWY
Provider Second Line Business Practice Location Address:
SUITE M-6A
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77706-6923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-899-2644
Provider Business Practice Location Address Fax Number:
409-899-2645
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FONTENOT
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
SERVICE DIRECTOR
Authorized Official Telephone Number:
713-855-6311

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  800158 , 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: 186922401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800158 . This is a "AMBULANCE LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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