Healthcare Provider Details

I. General information

NPI: 1114968963
Provider Name (Legal Business Name): AMERITECH MOBILE MEDICAL SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 VILLA DR STE. 101
EULESS TX
76040-4249
US

IV. Provider business mailing address

1010 VILLA DR STE. 101
EULESS TX
76040-4249
US

V. Phone/Fax

Practice location:
  • Phone: 817-540-6669
  • Fax: 817-545-0554
Mailing address:
  • Phone: 817-540-6669
  • Fax: 817-545-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number300093
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number300093
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number300093
License Number StateTX

VIII. Authorized Official

Name: RHON ROMMER
Title or Position: ADMINISTRATOR
Credential:
Phone: 817-540-6669