Provider Demographics
NPI:1497773246
Name:EMERALD AMBULANCE SERVICE LLC.
Entity Type:Organization
Organization Name:EMERALD AMBULANCE SERVICE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTELO
Authorized Official - Suffix:
Authorized Official - Credentials:EMT PARAMEDIC
Authorized Official - Phone:210-694-4508
Mailing Address - Street 1:PO BOX 690193
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-0193
Mailing Address - Country:US
Mailing Address - Phone:210-694-4508
Mailing Address - Fax:210-877-6004
Practice Address - Street 1:3817 PARKDALE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2390
Practice Address - Country:US
Practice Address - Phone:210-694-4505
Practice Address - Fax:210-877-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0151103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1651705Medicaid
TX1651705Medicaid