1053661140 NPI number — MEDICS LINKS EMS INC

Table of content: (NPI 1053661140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053661140 NPI number — MEDICS LINKS EMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICS LINKS EMS 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:
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:
1053661140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
990 INTERSTATE 10 N
Provider Second Line Business Mailing Address:
SUITE 145 BOX 23
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77702-1051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-892-1307
Provider Business Mailing Address Fax Number:
832-442-4360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 INTERSTATE 10 N
Provider Second Line Business Practice Location Address:
SUITE 145 BOX 23
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77702-1051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-892-1307
Provider Business Practice Location Address Fax Number:
832-442-4360
Provider Enumeration Date:
09/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
EPIE
Authorized Official First Name:
VALENTINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
409-892-1307

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1000774 , 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: 1000774 . This is a "TEXAS DEPARTMENT OF STATE HEALTH SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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