MEDICARE: VILLAGE OF SURFSIDE BEACH TEXAS

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	341600000X	Ambulance	800108	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316165962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF SURFSIDE BEACH TEXAS

Provider Business Mailing Address
First Line	:	P.O. BOX 691363
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77269-1363
Country	:	US
Telephone Number	:	281-397-0397
Fax Number	:	281-397-6934

Provider Business Practice Location Address
First Line	:	1304 MONUMENT DR
Second Line	:
City	:	SURFSIDE BCH
State	:	TX
Zip	:	77541-9522
Country	:	US
Telephone Number	:	979-239-1151
Fax Number	:	979-373-0699

Authorized Official
Title or Position	:	POLICE CHIEF
Name	:	GARY W PHILLIPS
Credential	:
Telephone Number	:	979-239-1151

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	06/23/2016

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Directions to “VILLAGE OF SURFSIDE BEACH TEXAS ” Practice Location

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