Provider Demographics
NPI:1467466326
Name:MEDINA VALLEY EMS INCORPORATED
Entity Type:Organization
Organization Name:MEDINA VALLEY EMS INCORPORATED
Other - Org Name:MEDINA COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-931-2777
Mailing Address - Street 1:PO BOX 1367
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-1367
Mailing Address - Country:US
Mailing Address - Phone:830-931-2777
Mailing Address - Fax:830-931-2777
Practice Address - Street 1:800 MADRID
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-1367
Practice Address - Country:US
Practice Address - Phone:830-931-2777
Practice Address - Fax:830-931-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163005341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086608901Medicaid
TX504965OtherBCBS
TX504965Medicare PIN
TX086608901Medicaid