Provider Demographics
NPI:1972680734
Name:LA PALOMA EMS
Entity Type:Organization
Organization Name:LA PALOMA EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / EMS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:LYNE
Authorized Official - Last Name:BARRERA-WIGINTON
Authorized Official - Suffix:
Authorized Official - Credentials:LEMT-P
Authorized Official - Phone:361-348-2367
Mailing Address - Street 1:PO BOX 1290
Mailing Address - Street 2:145 NW FIRST ST
Mailing Address - City:PREMONT
Mailing Address - State:TX
Mailing Address - Zip Code:78375-1290
Mailing Address - Country:US
Mailing Address - Phone:361-348-2367
Mailing Address - Fax:361-348-2547
Practice Address - Street 1:145 NW FIRST ST
Practice Address - Street 2:
Practice Address - City:PREMONT
Practice Address - State:TX
Practice Address - Zip Code:78375-1290
Practice Address - Country:US
Practice Address - Phone:361-348-2367
Practice Address - Fax:361-348-2547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3416L0300X13416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000-5662-01Medicaid
TX528014Medicare ID - Type UnspecifiedMEDICARE