1508857020 NPI number — FRIO COUNTY EMS

Table of content: (NPI 1508857020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508857020 NPI number — FRIO COUNTY EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRIO COUNTY EMS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508857020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E SAN ANTONIO ST
Provider Second Line Business Mailing Address:
#5
Provider Business Mailing Address City Name:
PEARSALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78061-3145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-334-3201
Provider Business Mailing Address Fax Number:
830-334-0025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 E SAN ANTONIO ST
Provider Second Line Business Practice Location Address:
#5
Provider Business Practice Location Address City Name:
PEARSALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78061-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-334-3201
Provider Business Practice Location Address Fax Number:
830-334-0025
Provider Enumeration Date:
11/03/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOODWARD
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
H
Authorized Official Title or Position:
EMS ADMINISTRATOR
Authorized Official Telephone Number:
210-415-5588

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  082002 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0864399-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".