Provider Demographics
NPI:1396732327
Name:ROBERSON EMS
Entity type:Organization
Organization Name:ROBERSON EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-664-1661
Mailing Address - Street 1:98 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4980
Mailing Address - Country:US
Mailing Address - Phone:361-664-1661
Mailing Address - Fax:361-664-1223
Practice Address - Street 1:98 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4980
Practice Address - Country:US
Practice Address - Phone:361-664-1661
Practice Address - Fax:361-664-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1250033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX504108Medicare ID - Type UnspecifiedAMBULANCE PROVIDER