Provider Demographics
NPI:1093098089
Name:JENESIS EMERGENCY SERVICES,INC.
Entity Type:Organization
Organization Name:JENESIS EMERGENCY SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:AMPARO
Authorized Official - Last Name:MALACARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-324-8758
Mailing Address - Street 1:3501 CONVENT AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-4727
Mailing Address - Country:US
Mailing Address - Phone:956-712-3326
Mailing Address - Fax:956-712-3376
Practice Address - Street 1:3501 CONVENT AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-4727
Practice Address - Country:US
Practice Address - Phone:956-712-3326
Practice Address - Fax:956-712-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10006993416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN