Provider Demographics
NPI:1114203056
Name:SKYLINE AMBULANCE SERVICES LLC
Entity Type:Organization
Organization Name:SKYLINE AMBULANCE SERVICES LLC
Other - Org Name:SKYLINE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATHILDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-448-9118
Mailing Address - Street 1:9700 LEAWOOD BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-2657
Mailing Address - Country:US
Mailing Address - Phone:713-448-9118
Mailing Address - Fax:682-323-2856
Practice Address - Street 1:9700 LEAWOOD BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-2657
Practice Address - Country:US
Practice Address - Phone:713-448-9118
Practice Address - Fax:682-323-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10007133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport