Provider Demographics
NPI:1629016290
Name:LIBERTY EMS, LLC
Entity Type:Organization
Organization Name:LIBERTY EMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:EMS
Authorized Official - Phone:956-381-8838
Mailing Address - Street 1:2512 W FREDDY GONZALEZ DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7339
Mailing Address - Country:US
Mailing Address - Phone:956-381-8838
Mailing Address - Fax:
Practice Address - Street 1:2512 W FREDDY GONZALEZ DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7339
Practice Address - Country:US
Practice Address - Phone:956-381-8838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108063341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00298475OtherRAILROAD MEDICARE
TXAMB372Medicare ID - Type Unspecified