Healthcare Provider Details

I. General information

NPI: 1306862586
Provider Name (Legal Business Name): GROVETON EMERGENCY MEDICAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SECOND ST
GROVETON TX
75845-7700
US

IV. Provider business mailing address

PO BOX 691363
HOUSTON TX
77269-1363
US

V. Phone/Fax

Practice location:
  • Phone: 936-642-1212
  • Fax: 936-642-0191
Mailing address:
  • Phone: 281-397-0397
  • Fax: 281-397-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number228003
License Number StateTX

VIII. Authorized Official

Name: DAVID ROBISON
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 936-642-1212