Provider Demographics
NPI:1184738213
Name:CITY OF BENAVIDES EMS
Entity type:Organization
Organization Name:CITY OF BENAVIDES EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:361-256-3881
Mailing Address - Street 1:DRAWER R
Mailing Address - Street 2:
Mailing Address - City:BENAVIDES
Mailing Address - State:TX
Mailing Address - Zip Code:78341
Mailing Address - Country:US
Mailing Address - Phone:361-256-3881
Mailing Address - Fax:361-256-3915
Practice Address - Street 1:213 NORTH CLARK
Practice Address - Street 2:
Practice Address - City:BENAVIDES
Practice Address - State:TX
Practice Address - Zip Code:78341
Practice Address - Country:US
Practice Address - Phone:361-256-3881
Practice Address - Fax:361-256-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-08-08
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-08
Provider Licenses
StateLicense IDTaxonomies
TX0660043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX506854Medicare PIN