Provider Demographics
NPI:1649568478
Name:PRUDENCE AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:PRUDENCE AMBULANCE SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-551-7000
Mailing Address - Street 1:2600 E VILLA MARIA RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2000
Mailing Address - Country:US
Mailing Address - Phone:979-551-7001
Mailing Address - Fax:979-200-2084
Practice Address - Street 1:2600 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2000
Practice Address - Country:US
Practice Address - Phone:979-551-7001
Practice Address - Fax:979-200-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000657341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance