1538162383 NPI number — THREE RIVERS AMBULANCE SERVICE, INC

Table of content: (NPI 1538162383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538162383 NPI number — THREE RIVERS AMBULANCE SERVICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THREE RIVERS AMBULANCE SERVICE, INC
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:
THREE RIVERS AMBULANCE SERVICE
Provider Other Organization Name Type Code:
5
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:
1538162383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2444
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEPHENVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-918-5388
Provider Business Mailing Address Fax Number:
866-711-3793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROWELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79227-9800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-918-5388
Provider Business Practice Location Address Fax Number:
866-711-3793
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FEEMSTER
Authorized Official First Name:
BOBBY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
254-918-5388

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 078002 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 515724 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000474901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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