Provider Demographics
NPI:1356324446
Name:CITY OF MIDLAND AMBULANCE SERVICE
Entity type:Organization
Organization Name:CITY OF MIDLAND AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MENCHACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-685-7203
Mailing Address - Street 1:PO BOX 1152
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79702-1152
Mailing Address - Country:US
Mailing Address - Phone:432-682-2154
Mailing Address - Fax:
Practice Address - Street 1:300 N LORAINE ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-4725
Practice Address - Country:US
Practice Address - Phone:432-685-7203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAMB165002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086597401Medicaid
504886Medicare ID - Type Unspecified