MEDICARE: TEXAS REGIONAL AMBULANCE SERVICE, 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	341600000X	Ambulance	800220	TX

General Provider Information

NPI Number	:	1578620365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS REGIONAL AMBULANCE SERVICE, LLC

Provider Business Mailing Address
First Line	:	5334 PRUDENCE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-5117
Country	:	US
Telephone Number	:	713-434-5300
Fax Number	:	713-434-5304

Provider Business Practice Location Address
First Line	:	5334 PRUDENCE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-5117
Country	:	US
Telephone Number	:	713-434-5300
Fax Number	:	713-434-5304

Authorized Official
Title or Position	:	OWNER
Name	:	JUAN TORRES
Credential	:
Telephone Number	:	713-434-5300

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	10/23/2007

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