Provider Demographics
NPI:1114968963
Name:AMERITECH MOBILE MEDICAL SYSTEMS, LLC
Entity Type:Organization
Organization Name:AMERITECH MOBILE MEDICAL SYSTEMS, LLC
Other - Org Name:AMERITECH AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-540-6669
Mailing Address - Street 1:1010 VILLA DR
Mailing Address - Street 2:STE. 101
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-4249
Mailing Address - Country:US
Mailing Address - Phone:817-540-6669
Mailing Address - Fax:817-545-0554
Practice Address - Street 1:1010 VILLA DR
Practice Address - Street 2:STE. 101
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-4249
Practice Address - Country:US
Practice Address - Phone:817-540-6669
Practice Address - Fax:817-545-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300093341600000X, 3416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX590012033OtherRAILROAD MEDICARE
TX10020741Medicaid
TX000613201Medicaid
TX528199Medicare PIN
TX590012033OtherRAILROAD MEDICARE
TX590012033Medicare ID - Type UnspecifiedRAILROAD MEDICARE