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General NPI Number Information
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NPI Number | 1598214538
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Entity Type | Organization
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Legal Business Name | AMBULANCE SERVICE ELYSIUM LLC
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Dates
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Enumeration Date | 10/03/2016
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 227 N LOOP 1604 E 150
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1260
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Country | US
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Telephone | 832-894-1965
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Fax | 832-383-4406
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Provider Business Mailing Address
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Address Line | 227 N LOOP 1604 E 150
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1260
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Country | US
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Telephone | 832-894-1965
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Fax | 832-383-4406
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Authorized Official
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Title or Position | OWNER
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Name | GORDAN WOODROFFE
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Credential |
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Telephone | 832-894-1965
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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 | 1000953
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License Number State | TX
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