Provider Demographics
NPI:1508361528
Name:DELTA EMERGENCY MEDICAL CORP
Entity Type:Organization
Organization Name:DELTA EMERGENCY MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:787-639-7737
Mailing Address - Street 1:RR 1 BOX 11475
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-9330
Mailing Address - Country:US
Mailing Address - Phone:787-677-4804
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 723 KILOMETRO 5.1
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-677-4804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3547341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance