MEDICARE: MITCHELL COUNTY AMBULANCE SERVICE

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
2	341600000X	Ambulance	168002	TX
3	3416L0300X	Land Ambulance

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

General Provider Information

NPI Number	:	1598763708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL COUNTY AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	997 W INTERSTATE 20
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-2685
Country	:	US
Telephone Number	:	325-728-3431
Fax Number	:	325-728-8974

Provider Business Practice Location Address
First Line	:	997 W INTERSTATE 20
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-2685
Country	:	US
Telephone Number	:	325-728-3431
Fax Number	:	325-728-8974

Authorized Official
Title or Position	:	CEO
Name	:	SUZANNE MICHELLE GAFFORD
Credential	:
Telephone Number	:	325-728-3431

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/30/2024

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Directions to “MITCHELL COUNTY AMBULANCE SERVICE ” Practice Location

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