Provider Demographics
NPI:1821030453
Name:AMISTAD AMBULANCE TRANSPORTS, LLC
Entity Type:Organization
Organization Name:AMISTAD AMBULANCE TRANSPORTS, LLC
Other - Org Name:AMISTAD AMBULANCE TRANSPORTS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-298-9796
Mailing Address - Street 1:3912 E HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-8810
Mailing Address - Country:US
Mailing Address - Phone:830-298-9796
Mailing Address - Fax:830-298-3040
Practice Address - Street 1:3912 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8810
Practice Address - Country:US
Practice Address - Phone:877-298-8796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8001453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB837OtherBLUE CROSS
TX800145OtherAMBULANCE SERVICE LICENSE
TXAMB837OtherBLUE CROSS
TXAMB837OtherBLUE CROSS
TXAMB522Medicare PIN