Healthcare Provider Details

I. General information

NPI: 1255498952
Provider Name (Legal Business Name): CITY OF DEVINE AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S TEEL DR
DEVINE TX
78016-3211
US

IV. Provider business mailing address

303 S TEEL DR
DEVINE TX
78016-3211
US

V. Phone/Fax

Practice location:
  • Phone: 830-663-2121
  • Fax: 830-663-2500
Mailing address:
  • Phone: 830-663-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number163004
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number163004
License Number StateTX

VIII. Authorized Official

Name: MR. MIKE FARRIS
Title or Position: ADMINISTRATOR
Credential: LIC-P
Phone: 830-663-2121