Provider Demographics
NPI:1881676294
Name:CITY OF BOOKER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:CITY OF BOOKER AMBULANCE SERVICE
Other - Org Name:BOOKER AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUPITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-658-4579
Mailing Address - Street 1:214 S , MAIN
Mailing Address - Street 2:P.O BOX M
Mailing Address - City:BOOKER
Mailing Address - State:TX
Mailing Address - Zip Code:79005-0450
Mailing Address - Country:US
Mailing Address - Phone:806-658-4579
Mailing Address - Fax:806-658-9627
Practice Address - Street 1:214 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:BOOKER
Practice Address - State:TX
Practice Address - Zip Code:79005
Practice Address - Country:US
Practice Address - Phone:806-658-4579
Practice Address - Fax:806-658-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX506522Medicare ID - Type Unspecified
TX148002Medicare UPIN