Provider Demographics
NPI:1497824569
Name:GEMINI AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:GEMINI AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDAZO
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:210-488-9801
Mailing Address - Street 1:14220 NORTHBROOK DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5076
Mailing Address - Country:US
Mailing Address - Phone:210-488-9800
Mailing Address - Fax:210-488-9802
Practice Address - Street 1:14220 NORTHBROOK DR
Practice Address - Street 2:SUITE 700
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5076
Practice Address - Country:US
Practice Address - Phone:210-488-9800
Practice Address - Fax:210-488-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015097341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000760101Medicaid
TX000760101Medicaid