Provider Demographics
NPI:1558509521
Name:DELTA AMBULANCE SERVICE, LLC
Entity Type:Organization
Organization Name:DELTA AMBULANCE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-292-9541
Mailing Address - Street 1:PO BOX 2129
Mailing Address - Street 2:215 N BROADWAY
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543-2129
Mailing Address - Country:US
Mailing Address - Phone:956-292-9541
Mailing Address - Fax:
Practice Address - Street 1:215 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-2129
Practice Address - Country:US
Practice Address - Phone:956-292-9541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000217341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000217OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES EMS PROVIDER FIRM