Provider Demographics
NPI:1023255874
Name:SACRED HEART EMS, INC
Entity type:Organization
Organization Name:SACRED HEART EMS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BO
Authorized Official - Middle Name:
Authorized Official - Last Name:REGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-579-9727
Mailing Address - Street 1:PO BOX 3847
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3847
Mailing Address - Country:US
Mailing Address - Phone:361-649-0814
Mailing Address - Fax:
Practice Address - Street 1:2901 N CAMERON ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3931
Practice Address - Country:US
Practice Address - Phone:361-649-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
TX1000203341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201481301Medicaid