Provider Demographics
NPI:1336478957
Name:PBD SERVICES 1 LLC
Entity Type:Organization
Organization Name:PBD SERVICES 1 LLC
Other - Org Name:GUARDIAN EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:214-770-7895
Mailing Address - Street 1:PO BOX 1968
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1968
Mailing Address - Country:US
Mailing Address - Phone:972-218-0153
Mailing Address - Fax:214-200-9198
Practice Address - Street 1:4101 RICE DRIER
Practice Address - Street 2:SUITE 2A
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581
Practice Address - Country:US
Practice Address - Phone:713-714-2980
Practice Address - Fax:214-200-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341600000X
TX10004243416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB1035Medicare PIN
TX214580701Medicaid