MEDICARE: CRYSTAL CITY EMS

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	254003	TX

General Provider Information

NPI Number	:	1972553105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL CITY EMS

Provider Business Mailing Address
First Line	:	101 E DIMMIT ST
Second Line	:
City	:	CRYSTAL CITY
State	:	TX
Zip	:	78839-3505
Country	:	US
Telephone Number	:	830-374-3477
Fax Number	:	830-374-2123

Provider Business Practice Location Address
First Line	:	101 E DIMMIT ST
Second Line	:
City	:	CRYSTAL CITY
State	:	TX
Zip	:	78839-3505
Country	:	US
Telephone Number	:	830-374-3477
Fax Number	:	830-374-2123

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	KIMBERLY T SAMANIEGO-MARTINEZ
Credential	:
Telephone Number	:	830-374-3477

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	02/21/2008

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Directions to “CRYSTAL CITY EMS ” Practice Location

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