Provider Demographics
NPI:1336381870
Name:JCSD EMERGENCY MEDICAL GROUP INC
Entity type:Organization
Organization Name:JCSD EMERGENCY MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:972-554-9300
Mailing Address - Street 1:PO BOX 34837
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-4837
Mailing Address - Country:US
Mailing Address - Phone:972-554-9300
Mailing Address - Fax:972-554-9302
Practice Address - Street 1:14286 GILLIS RD
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-3722
Practice Address - Country:US
Practice Address - Phone:972-554-9300
Practice Address - Fax:972-554-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10002333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202976101Medicaid