Provider Demographics
NPI:1801972856
Name:SCHLEICHER COUNTY VOLUNTEER EMERGENCY MEDICAL SERVICE
Entity type:Organization
Organization Name:SCHLEICHER COUNTY VOLUNTEER EMERGENCY MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEIISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-853-3456
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:TX
Mailing Address - Zip Code:76936-0637
Mailing Address - Country:US
Mailing Address - Phone:325-853-3456
Mailing Address - Fax:325-853-4136
Practice Address - Street 1:305 EAST MURCHISON
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:TX
Practice Address - Zip Code:76936-0637
Practice Address - Country:US
Practice Address - Phone:325-853-3456
Practice Address - Fax:325-853-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2070013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0001497-01Medicaid
TX207001OtherDSHS PROVIDER #
TX0001497-01Medicaid
TX506985Medicare PIN