Provider Demographics
NPI:1548439748
Name:ITC MEDICAL TRANSPORT COMPANY, INC.
Entity type:Organization
Organization Name:ITC MEDICAL TRANSPORT COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-334-5870
Mailing Address - Street 1:PO BOX 7619
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78467-7619
Mailing Address - Country:US
Mailing Address - Phone:361-334-5870
Mailing Address - Fax:361-334-5871
Practice Address - Street 1:4325 KOSTORYZ RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5018
Practice Address - Country:US
Practice Address - Phone:361-334-5870
Practice Address - Fax:361-334-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10001093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19674301Medicaid
TXAMB689Medicare PIN