Healthcare Provider Details

I. General information

NPI: 1669569166
Provider Name (Legal Business Name): ROAD RUNNER EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14930 DIPPLE LEHMAN
NEEDVILLE TX
77461
US

IV. Provider business mailing address

14930 DIPPLE LEHMAN
NEEDVILLE TX
77461
US

V. Phone/Fax

Practice location:
  • Phone: 979-793-7482
  • Fax:
Mailing address:
  • Phone: 979-793-7482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number800178
License Number StateTX

VIII. Authorized Official

Name: EDWIN H CISNEROS
Title or Position: CEO
Credential:
Phone: 979-793-7482