Provider Demographics
NPI:1902951007
Name:LA VERNIA VOLUNTEER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:LA VERNIA VOLUNTEER AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, LA VERNIA VOLUNTEER AMBU
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-779-1709
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-0308
Mailing Address - Country:US
Mailing Address - Phone:830-779-1709
Mailing Address - Fax:830-779-5049
Practice Address - Street 1:12033 HWY 87 WEST
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121
Practice Address - Country:US
Practice Address - Phone:830-779-1709
Practice Address - Fax:830-779-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247005341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0865925-01Medicaid
TX700722OtherUNITED HEALTHCARE
TX0000504860OtherBLUE CROSS BLUE SHIELD TX
TX504860Medicare PIN