=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336145275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAT EMS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2005
-----------------------------------------------------
Last Update Date | 01/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3511 W US HIGHWAY 83
-----------------------------------------------------
City | RIO GRANDE CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78582-6569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-488-1111
-----------------------------------------------------
Fax | 956-488-1101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3511 W US HIGHWAY 83
-----------------------------------------------------
City | RIO GRANDE CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78582-6569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-488-1111
-----------------------------------------------------
Fax | 956-488-1101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS DIRECTOR
-----------------------------------------------------
Name | MARTIN GARCIA
-----------------------------------------------------
Credential | PARAMEDIC
-----------------------------------------------------
Telephone | 956-488-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 300271
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------