Provider Demographics
NPI:1881646206
Name:MED-TECH AMBULANCE
Entity Type:Organization
Organization Name:MED-TECH AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-580-5262
Mailing Address - Street 1:4301 BRAZOS AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79764-3937
Mailing Address - Country:US
Mailing Address - Phone:432-580-5262
Mailing Address - Fax:432-550-8943
Practice Address - Street 1:4301 BRAZOS AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79764-3937
Practice Address - Country:US
Practice Address - Phone:432-580-5262
Practice Address - Fax:432-550-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX068005341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528156Medicare ID - Type Unspecified