Provider Demographics
NPI:1942201272
Name:LONE STAR AMBULANCE, INC
Entity Type:Organization
Organization Name:LONE STAR AMBULANCE, INC
Other - Org Name:LONE STAR AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CAUTHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-832-0272
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-0787
Mailing Address - Country:US
Mailing Address - Phone:409-832-0272
Mailing Address - Fax:866-206-2306
Practice Address - Street 1:3700 FREDERICKSBURG RD STE 139
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3268
Practice Address - Country:US
Practice Address - Phone:210-236-9055
Practice Address - Fax:210-881-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3001383416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000638901Medicaid
TX528271Medicare PIN