Provider Demographics
NPI:1285843805
Name:FREEDOM AMBULANCE LLC
Entity Type:Organization
Organization Name:FREEDOM AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:361-358-4808
Mailing Address - Street 1:104 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-4830
Mailing Address - Country:US
Mailing Address - Phone:361-358-4808
Mailing Address - Fax:361-358-4810
Practice Address - Street 1:104 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-4830
Practice Address - Country:US
Practice Address - Phone:361-358-4808
Practice Address - Fax:361-358-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10000233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187627802Medicaid
TXAMB871OtherBCBS PIN
TX187627802Medicaid