Provider Demographics
NPI:1629007471
Name:ST. MARY'S AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:ST. MARY'S AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:EMS
Authorized Official - Phone:956-447-5151
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-0070
Mailing Address - Country:US
Mailing Address - Phone:956-447-5151
Mailing Address - Fax:
Practice Address - Street 1:412 E 18TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-8032
Practice Address - Country:US
Practice Address - Phone:956-447-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108061341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00110399OtherRAILROAD
TXP00110399OtherRAILROAD