Provider Demographics
NPI:1023348471
Name:EAGLE AMBULANCE LLC
Entity type:Organization
Organization Name:EAGLE AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-927-9083
Mailing Address - Street 1:3201 G N HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-2673
Mailing Address - Country:US
Mailing Address - Phone:713-927-9083
Mailing Address - Fax:713-290-9047
Practice Address - Street 1:3201 G N HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-2673
Practice Address - Country:US
Practice Address - Phone:713-927-9083
Practice Address - Fax:713-290-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10000603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN