MEDICARE: X-TRA MILE AMBULANCE SERVIC4E

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	108067	TX

General Provider Information

NPI Number	:	1053313320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	X-TRA MILE AMBULANCE SERVIC4E

Provider Business Mailing Address
First Line	:	PO BOX 2671
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78540-2671
Country	:	US
Telephone Number	:	956-239-0986
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E EXPY 83
Second Line	:	STE J
City	:	PHARR
State	:	TX
Zip	:	78577-6500
Country	:	US
Telephone Number	:	956-783-2709
Fax Number	:	956-702-1145

Authorized Official
Title or Position	:	OWNER
Name	:	MR. NEIL CRUZ
Credential	:
Telephone Number	:	956-239-0986

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/22/2020

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