Provider Demographics
NPI:1255587606
Name:GATEWAY AMBULANCE SERVICE,LLC
Entity type:Organization
Organization Name:GATEWAY AMBULANCE SERVICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BONDOC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-753-6411
Mailing Address - Street 1:720 LAREDO ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5218
Mailing Address - Country:US
Mailing Address - Phone:956-753-6411
Mailing Address - Fax:956-753-6412
Practice Address - Street 1:720 LAREDO ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-7917
Practice Address - Country:US
Practice Address - Phone:956-753-6411
Practice Address - Fax:956-753-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10001643416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197191301Medicaid
TXAMB734Medicare UPIN