MEDICARE: SAN SABA COUNTY

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	1000911	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000911	OTHER	TX	EMERGENCY MEDICAL SERVICES PROVIDER LICENSE

General Provider Information

NPI Number	:	1134556434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN SABA COUNTY

Provider Business Mailing Address
First Line	:	607 E COMMERCE ST
Second Line	:
City	:	SAN SABA
State	:	TX
Zip	:	76877-4702
Country	:	US
Telephone Number	:	325-372-6016
Fax Number	:	325-372-3809

Provider Business Practice Location Address
First Line	:	607 E COMMERCE ST
Second Line	:
City	:	SAN SABA
State	:	TX
Zip	:	76877-4702
Country	:	US
Telephone Number	:	325-372-6016
Fax Number	:	325-372-3809

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	MS. PATRICIA ANN PRATT
Credential	:	LP
Telephone Number	:	325-205-0089

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	12/10/2013

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Directions to “SAN SABA COUNTY ” Practice Location

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