Provider Demographics
NPI:1760400568
Name:MCLEAN EMS
Entity Type:Organization
Organization Name:MCLEAN EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-779-2484
Mailing Address - Street 1:3005 S LAMAR BLVD
Mailing Address - Street 2:SUITE D109-372
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:866-766-9471
Mailing Address - Fax:512-275-3725
Practice Address - Street 1:113 2ND ST
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:TX
Practice Address - Zip Code:79057
Practice Address - Country:US
Practice Address - Phone:806-779-2872
Practice Address - Fax:806-779-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0900043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTY4571OtherHEALTHNET
TXTY4571OtherHEALTHNET
TX514908Medicare ID - Type Unspecified