MEDICARE: PRO MEDIC EMS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146N00000X	Basic Emergency Medical Technician	300178	TX

General Provider Information

NPI Number	:	1295712057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO MEDIC EMS LLC

Provider Business Mailing Address
First Line	:	PO BOX 2190
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589-7190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 N TOWER RD
Second Line	:
City	:	ALAMO
State	:	TX
Zip	:	78516
Country	:	US
Telephone Number	:	956-702-7577
Fax Number	:	956-782-7756

Authorized Official
Title or Position	:	CEO
Name	:	MR. JESUS FLORES
Credential	:	CEO
Telephone Number	:	956-782-6696

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	05/24/2013

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