Provider Demographics
NPI:1760486351
Name:LIPAN AMBULANCE SERVICE
Entity Type:Organization
Organization Name:LIPAN AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:MASCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:REG MA
Authorized Official - Phone:903-473-0927
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:LIPAN
Mailing Address - State:TX
Mailing Address - Zip Code:76462-0277
Mailing Address - Country:US
Mailing Address - Phone:903-473-0927
Mailing Address - Fax:832-877-5040
Practice Address - Street 1:204 E LIPAN DR
Practice Address - Street 2:
Practice Address - City:LIPAN
Practice Address - State:TX
Practice Address - Zip Code:76462-2206
Practice Address - Country:US
Practice Address - Phone:903-473-0927
Practice Address - Fax:832-877-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX504330OtherBCBS TEXAS
TX140460001Medicaid
TX140460001Medicaid