Provider Demographics
NPI:1073539425
Name:THIRD COAST AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:THIRD COAST AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:361-806-0911
Mailing Address - Street 1:PO BOX 7547
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78467-7547
Mailing Address - Country:US
Mailing Address - Phone:361-806-0911
Mailing Address - Fax:361-334-5664
Practice Address - Street 1:5959 S STAPLES ST
Practice Address - Street 2:SUITE 211
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3846
Practice Address - Country:US
Practice Address - Phone:361-806-0911
Practice Address - Fax:361-334-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800111341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181585402Medicaid
TXAMB501Medicare PIN