=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467644559
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE EMERGENCY MEDICAL SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2007
-----------------------------------------------------
Last Update Date | 06/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1814 VICTORIA ST
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78572-6403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-683-7444
-----------------------------------------------------
Fax | 956-683-7449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 S SHARY RD STE 5 PMB# 186
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78572-8568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-583-7447
-----------------------------------------------------
Fax | 956-583-7455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSITANT DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | GUADALUPE DEJESUS CORDERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-240-2315
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1000348
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------