Provider Demographics
NPI:1245338664
Name:MTA AMBULANCE SERVICE OF LUBBOCK, LLC
Entity type:Organization
Organization Name:MTA AMBULANCE SERVICE OF LUBBOCK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:MCGUIRE
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-747-4873
Mailing Address - Street 1:4523 HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-9609
Mailing Address - Country:US
Mailing Address - Phone:806-747-4873
Mailing Address - Fax:806-747-4871
Practice Address - Street 1:4523 HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-9609
Practice Address - Country:US
Practice Address - Phone:806-747-4873
Practice Address - Fax:806-747-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8000863416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport