Provider Demographics
NPI:1922392406
Name:INTERCITY AMBULANCE FOR EMERGENCY MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:INTERCITY AMBULANCE FOR EMERGENCY MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:956-407-7744
Mailing Address - Street 1:5702 BOGART DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-1558
Mailing Address - Country:US
Mailing Address - Phone:956-407-7744
Mailing Address - Fax:
Practice Address - Street 1:5702 BOGART DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-1558
Practice Address - Country:US
Practice Address - Phone:956-407-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000631341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283981301Medicaid
TX283981301Medicaid