1902951007 NPI number — LA VERNIA VOLUNTEER AMBULANCE SERVICE

Table of content: (NPI 1902951007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902951007 NPI number — LA VERNIA VOLUNTEER AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA VERNIA VOLUNTEER 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:
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:
1902951007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA VERNIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78121-0308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-779-1709
Provider Business Mailing Address Fax Number:
830-779-5049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12033 HWY 87 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA VERNIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-779-1709
Provider Business Practice Location Address Fax Number:
830-779-5049
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RYE
Authorized Official First Name:
MARIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, LA VERNIA VOLUNTEER AMBU
Authorized Official Telephone Number:
830-779-1709

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  247005 , 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: 247005 , 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: 0865925-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700722 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0000504860 . This is a "BLUE CROSS BLUE SHIELD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com