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General NPI Number Information
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NPI Number | 1639405855
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Entity Type | Organization
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Legal Business Name | KERRVILLE MED EXPRESS
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 12/13/2013
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Provider Practice Location Address
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Address Line | 2217 PADRE BLVD
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City | SOUTH PADRE ISLAND
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State | TX
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Zip | 78597
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Country | US
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Telephone | 956-761-4649
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Fax | 866-594-1025
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Provider Business Mailing Address
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Address Line | 2217 PADRE BLVD
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City | SOUTH PADRE ISLAND
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State | TX
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Zip | 78597
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Country | US
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Telephone | 956-761-4649
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Fax | 866-594-1025
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Authorized Official
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Title or Position | PHYSICIAN/MEDICAL DIRECTOR
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Name | DR. RICHARD BRUCE DEBENEDETTO
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Credential | M.D.
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Telephone | 956-761-4649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | J9579
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J9579
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License Number State | TX
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