Provider Demographics
NPI:1669569166
Name:ROAD RUNNER EMS
Entity type:Organization
Organization Name:ROAD RUNNER EMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-793-7482
Mailing Address - Street 1:14930 DIPPLE LEHMAN
Mailing Address - Street 2:
Mailing Address - City:NEEDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77461
Mailing Address - Country:US
Mailing Address - Phone:979-793-7482
Mailing Address - Fax:
Practice Address - Street 1:14930 DIPPLE LEHMAN
Practice Address - Street 2:
Practice Address - City:NEEDVILLE
Practice Address - State:TX
Practice Address - Zip Code:77461
Practice Address - Country:US
Practice Address - Phone:979-793-7482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800178341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN