Provider Demographics
NPI:1629216254
Name:PROTEC AMBULANCE TRANSPORT
Entity Type:Organization
Organization Name:PROTEC AMBULANCE TRANSPORT
Other - Org Name:CROSSROADS EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-548-7771
Mailing Address - Street 1:PO BOX 1708
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-1708
Mailing Address - Country:US
Mailing Address - Phone:281-330-0330
Mailing Address - Fax:
Practice Address - Street 1:900 GRANBERRY ST
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4757
Practice Address - Country:US
Practice Address - Phone:281-548-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800078341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01007722OtherRAILROAD
TX203994301Medicaid
TXP01007722OtherRAILROAD