Healthcare Provider Details

I. General information

NPI: 1033199161
Provider Name (Legal Business Name): EMS MEDIVENTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E 4TH ST
LAMPASAS TX
76550-2833
US

IV. Provider business mailing address

204 E 4TH ST
LAMPASAS TX
76550-2833
US

V. Phone/Fax

Practice location:
  • Phone: 512-556-0086
  • Fax: 512-556-0072
Mailing address:
  • Phone: 512-556-0086
  • Fax: 512-556-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number141001
License Number StateTX

VIII. Authorized Official

Name: ROY COCKRELL
Title or Position: PRESIDENT
Credential: EMT-P
Phone: 512-556-0086