Provider Demographics
NPI:1609892272
Name:ADVANCE EMS, LTD.
Entity Type:Organization
Organization Name:ADVANCE EMS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KISLYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-661-3443
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0668
Mailing Address - Country:US
Mailing Address - Phone:713-661-3443
Mailing Address - Fax:713-661-3830
Practice Address - Street 1:5018 CHANCELLOR ROW
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-2106
Practice Address - Country:US
Practice Address - Phone:361-857-2059
Practice Address - Fax:361-857-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPP234333300000X
TX300358341600000X
TX3002583416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No333300000XSuppliersEmergency Response System Companies
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190687701Medicaid
TXAMB538OtherBC/BS OF TEXAS
TX000729601Medicaid
TXAMB573Medicare PIN