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General NPI Number Information
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NPI Number | 1033458385
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Entity Type | Organization
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Legal Business Name | DPAR ROADRUNNER LLC, DBA ALLEGIANCE AMBULANCE
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 501 S AUSTIN AVE SUITE 1310
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City | GEORGETOWN
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State | TX
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Zip | 78626-5637
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Country | US
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Telephone | 855-576-7450
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2775
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City | GEORGETOWN
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State | TX
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Zip | 78627-2775
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Country | US
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Telephone | 855-576-7450
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. AARON REESE
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Credential |
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Telephone | 855-576-7450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1000869
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License Number State | TX
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