Provider Demographics
NPI:1023177961
Name:SOUTHERNCROSS AMBULANCE, INC.
Entity type:Organization
Organization Name:SOUTHERNCROSS AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CALIXTO
Authorized Official - Middle Name:JUVAL
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:512-373-5115
Mailing Address - Street 1:PO BOX 311295
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-1295
Mailing Address - Country:US
Mailing Address - Phone:512-373-5115
Mailing Address - Fax:888-607-0857
Practice Address - Street 1:1718 STATE HIGHWAY 46 SOUTH
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78131
Practice Address - Country:US
Practice Address - Phone:830-629-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX046006146L00000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes341600000XTransportation ServicesAmbulance
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000592801Medicaid