Provider Demographics
NPI:1932428257
Name:BRONZESTAR AMBULANCE SERVICE LLC
Entity type:Organization
Organization Name:BRONZESTAR AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE/ADMINISTRATO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-712-3667
Mailing Address - Street 1:P.O. BOX 451750
Mailing Address - Street 2:BRONZESTAR AMBULANCE LLC
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0043
Mailing Address - Country:US
Mailing Address - Phone:956-712-3667
Mailing Address - Fax:956-753-6013
Practice Address - Street 1:5816 EAST DRIVE UNIT A
Practice Address - Street 2:BRONZESTAR AMBULANCE SERVICE LLC
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6851
Practice Address - Country:US
Practice Address - Phone:956-712-3667
Practice Address - Fax:956-753-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
TX1000454341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPIBASE#2185134Medicaid
TXTPIBASE#2185134Medicaid
TXAMB1024Medicare PIN
TXAMB1024Medicare UPIN