Provider Demographics
NPI:1053313320
Name:X-TRA MILE AMBULANCE SERVIC4E
Entity Type:Organization
Organization Name:X-TRA MILE AMBULANCE SERVIC4E
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-239-0986
Mailing Address - Street 1:PO BOX 2671
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-2671
Mailing Address - Country:US
Mailing Address - Phone:956-239-0986
Mailing Address - Fax:
Practice Address - Street 1:300 E EXPY 83
Practice Address - Street 2:STE J
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6500
Practice Address - Country:US
Practice Address - Phone:956-783-2709
Practice Address - Fax:956-702-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080673416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB407Medicare ID - Type Unspecified