Provider Demographics
NPI:1851395404
Name:MEDICAL RELIANCE AMBULANCE SERVICE
Entity Type:Organization
Organization Name:MEDICAL RELIANCE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:800-617-1213
Mailing Address - Street 1:7231 POSS RD
Mailing Address - Street 2:
Mailing Address - City:LEON VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3135
Mailing Address - Country:US
Mailing Address - Phone:800-617-1213
Mailing Address - Fax:800-617-1214
Practice Address - Street 1:7231 POSS RD
Practice Address - Street 2:
Practice Address - City:LEON VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78240-3135
Practice Address - Country:US
Practice Address - Phone:800-617-1213
Practice Address - Fax:800-617-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0151073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB625OtherBCBS TEXAS
TX1550496901Medicaid
TXAMB625OtherBCBS TEXAS