1871724864 NPI number — LONE STAR AMBULANCE 1, LLC

Table of content: (NPI 1871724864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871724864 NPI number — LONE STAR AMBULANCE 1, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONE STAR AMBULANCE 1, LLC
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:
6
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:
1871724864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2775
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78627-2775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-935-2424
Provider Business Mailing Address Fax Number:
254-935-2457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 N SHORELINE BLVD STE 906
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78401-0399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-576-7450
Provider Business Practice Location Address Fax Number:
512-869-1633
Provider Enumeration Date:
08/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
855-576-7450

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1000327 , 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: AMB906 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com