Healthcare Provider Details

I. General information

NPI: 1558411728
Provider Name (Legal Business Name): CITIZENS EMERGENCY MEDICAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SOUTH 2ND
CLYDE TX
79510
US

IV. Provider business mailing address

PO BOX 1556
CLYDE TX
79510-1556
US

V. Phone/Fax

Practice location:
  • Phone: 325-893-5754
  • Fax: 325-893-4127
Mailing address:
  • Phone: 325-893-5754
  • Fax: 325-893-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number030001
License Number StateTX

VIII. Authorized Official

Name: MRS. MARGO NICOLLE STAFFORD
Title or Position: EMS DIRECTOR
Credential: LP
Phone: 325-439-5150