Provider Demographics
NPI:1871724864
Name:LONE STAR AMBULANCE 1, LLC
Entity type:Organization
Organization Name:LONE STAR AMBULANCE 1, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-576-7450
Mailing Address - Street 1:PO BOX 2775
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-2775
Mailing Address - Country:US
Mailing Address - Phone:254-935-2424
Mailing Address - Fax:254-935-2457
Practice Address - Street 1:500 N SHORELINE BLVD STE 906
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-0399
Practice Address - Country:US
Practice Address - Phone:855-576-7450
Practice Address - Fax:512-869-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10003273416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB906OtherMEDICARE PTAN