Provider Demographics
NPI:1730352030
Name:ANGELGUARD MEDICAL TRANSPORTATION, INC.
Entity type:Organization
Organization Name:ANGELGUARD MEDICAL TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NWANKPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-716-1350
Mailing Address - Street 1:3000 JOE DIMAGGIO BLVD
Mailing Address - Street 2:SUITE #83
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3990
Mailing Address - Country:US
Mailing Address - Phone:512-716-1350
Mailing Address - Fax:
Practice Address - Street 1:3000 JOE DIMAGGIO BLVD
Practice Address - Street 2:SUITE #83
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3990
Practice Address - Country:US
Practice Address - Phone:512-716-1350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000119341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AMB692Medicare PIN