Healthcare Provider Details

I. General information

NPI: 1982914495
Provider Name (Legal Business Name): MEDEVAC EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 FORNEY RD SUITE 108
MESQUITE TX
75149-2747
US

IV. Provider business mailing address

201 LAURENCE DR PO BOX 202
HEATH TX
75032-2069
US

V. Phone/Fax

Practice location:
  • Phone: 972-623-8869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JASON ALAN WILLIAMS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 972-623-8859