Provider Demographics
NPI:1093865735
Name:LAREDO CRITICAL CARE AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:LAREDO CRITICAL CARE AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:G
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-795-0639
Mailing Address - Street 1:707 E CALTON RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3638
Mailing Address - Country:US
Mailing Address - Phone:956-795-0639
Mailing Address - Fax:956-795-0364
Practice Address - Street 1:707 E CALTON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3638
Practice Address - Country:US
Practice Address - Phone:956-795-0639
Practice Address - Fax:956-795-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3416L0300X341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1839797-01Medicaid
TXAMB845OtherBCBS
TX1839797-01Medicaid