Provider Demographics
NPI:1356504955
Name:SOUTHERN INTERPRISES
Entity Type:Organization
Organization Name:SOUTHERN INTERPRISES
Other - Org Name:COASTAL EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:JR
Authorized Official - Credentials:ECA
Authorized Official - Phone:956-240-8910
Mailing Address - Street 1:310 E. MAIN AVE
Mailing Address - Street 2:PMB 213
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573
Mailing Address - Country:US
Mailing Address - Phone:956-240-8910
Mailing Address - Fax:
Practice Address - Street 1:310 E MAIN AVE
Practice Address - Street 2:PMB 213
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-6872
Practice Address - Country:US
Practice Address - Phone:956-240-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance