Provider Demographics
NPI:1194770255
Name:SOUTHEAST TEXAS EMS
Entity type:Organization
Organization Name:SOUTHEAST TEXAS EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE & BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-898-4740
Mailing Address - Street 1:PO BOX 12898
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726
Mailing Address - Country:US
Mailing Address - Phone:409-898-4740
Mailing Address - Fax:409-898-4753
Practice Address - Street 1:5055 BRAGG CIRCLE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705
Practice Address - Country:US
Practice Address - Phone:409-898-4740
Practice Address - Fax:409-898-4753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1230263416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC148423001Medicaid
590015263OtherMCB RAILROAD
AMB604OtherBCBS
SC148423001Medicaid
TX1194770255Medicare PIN