1447454673 NPI number — BRAZORIA COUNTY EMS INC

Table of content: (NPI 1447454673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447454673 NPI number — BRAZORIA COUNTY EMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAZORIA COUNTY EMS 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:
Provider Other Organization Name Type Code:
6
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:
1447454673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3242
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77542-1442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-222-1335
Provider Business Mailing Address Fax Number:
979-266-9211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 N GULF BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEPORT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77541-4305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-222-1335
Provider Business Practice Location Address Fax Number:
979-266-9211
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOGAN
Authorized Official First Name:
BILL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-222-1335

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1000032 , 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: 185940701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: AMB874 . This is a "BC/BS OF TEXAS PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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