Provider Demographics
NPI:1063415107
Name:YORKTOWN EMERGENCY MEDICAL SERVICE
Entity type:Organization
Organization Name:YORKTOWN EMERGENCY MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-938-7080
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78164-0142
Mailing Address - Country:US
Mailing Address - Phone:361-564-9410
Mailing Address - Fax:361-564-9476
Practice Address - Street 1:508 N RIEDEL ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:TX
Practice Address - Zip Code:78164-1810
Practice Address - Country:US
Practice Address - Phone:361-564-9410
Practice Address - Fax:361-564-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0620083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX514705OtherBCBS PROVIDER NUMBER
TX062008OtherTDH LICENSE NUMBER
TX000404601Medicaid
TX514705Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER