MEDICARE: COUNTY OF KENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	132001	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	503940	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1083733703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF KENT

Provider Business Mailing Address
First Line	:	PO BOX 41
Second Line	:
City	:	JAYTON
State	:	TX
Zip	:	79528-0041
Country	:	US
Telephone Number	:	806-237-2582
Fax Number	:	806-237-2582

Provider Business Practice Location Address
First Line	:	831 S. MAIN
Second Line	:
City	:	JAYTON
State	:	TX
Zip	:	79528-0185
Country	:	US
Telephone Number	:	806-237-2582
Fax Number	:	806-237-2582

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	MR. HOWARD MILTON HEATH JR.
Credential	:
Telephone Number	:	806-269-3111

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	06/11/2012

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Directions to “COUNTY OF KENT ” Practice Location

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