1750373577 NPI number — GONZALES VOLUNTEER AMBULANCE CORPS.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750373577 NPI number — GONZALES VOLUNTEER AMBULANCE CORPS.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GONZALES VOLUNTEER AMBULANCE CORPS.
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:
1750373577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62
Provider Second Line Business Mailing Address:
1703 ST. JOSEPH ST.
Provider Business Mailing Address City Name:
GONZALES
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78629-0062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-672-7675
Provider Business Mailing Address Fax Number:
830-672-2222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1703 N SAINT JOSEPH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GONZALES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78629-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-672-7675
Provider Business Practice Location Address Fax Number:
830-672-2222
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
CARLA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
830-672-7675

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  089001 , 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: P00151720 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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