Provider Demographics
NPI:1033199161
Name:EMS MEDIVENTURE, INC.
Entity Type:Organization
Organization Name:EMS MEDIVENTURE, INC.
Other - Org Name:CAPITAL AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKRELL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:512-556-0086
Mailing Address - Street 1:204 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-2833
Mailing Address - Country:US
Mailing Address - Phone:512-556-0086
Mailing Address - Fax:512-556-0072
Practice Address - Street 1:204 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-2833
Practice Address - Country:US
Practice Address - Phone:512-556-0086
Practice Address - Fax:512-556-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1410013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AMB278Medicare ID - Type Unspecified