Provider Demographics
NPI:1548275514
Name:PECOS AMBULANCE SERVICE
Entity type:Organization
Organization Name:PECOS AMBULANCE SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THORP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-940-5725
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:TX
Mailing Address - Zip Code:79772-0009
Mailing Address - Country:US
Mailing Address - Phone:732-940-5725
Mailing Address - Fax:940-239-0312
Practice Address - Street 1:324 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772-3211
Practice Address - Country:US
Practice Address - Phone:432-940-5725
Practice Address - Fax:940-239-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX503174OtherBS/BS OF TEXAS
503174OtherRAILRAOD MEDICARE
TX503174Medicare PIN