=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649218710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROYALTY AMBULANCE SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4201 N 22ND ST
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-4143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-664-1246
-----------------------------------------------------
Fax | 956-683-1104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4201 N 22ND ST
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-4143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-664-1246
-----------------------------------------------------
Fax | 956-683-1104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE-PRESIDENT/ D.O.
-----------------------------------------------------
Name | MR. ANASTACIO J FARIAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-664-1246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 800091
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------