1548275514 NPI number — PECOS AMBULANCE SERVICE

Table of content: (NPI 1548275514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548275514 NPI number — PECOS AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PECOS AMBULANCE SERVICE
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:
PECOS VOLUNTEER AMBULANCE SERVICE INC.
Provider Other Organization Name Type Code:
3
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:
1548275514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PECOS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79772-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-940-5725
Provider Business Mailing Address Fax Number:
940-239-0312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 S CEDAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PECOS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79772-3211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-940-5725
Provider Business Practice Location Address Fax Number:
940-239-0312
Provider Enumeration Date:
07/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THORP
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS ADMINISTRATOR
Authorized Official Telephone Number:
432-940-5725

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  195001 , 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: 503174 . This is a "BS/BS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 503174 . This is a "RAILRAOD MEDICARE" identifier . This identifiers is of the category "OTHER".