Healthcare Provider Details

I. General information

NPI: 1295755106
Provider Name (Legal Business Name): PRESTON VOLUNTEER EMERGENCY SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14691 HIGHWAY 120 N
POTTSBORO TX
75076-3348
US

IV. Provider business mailing address

14691 HIGHWAY 120 N
POTTSBORO TX
75076-3348
US

V. Phone/Fax

Practice location:
  • Phone: 903-786-3010
  • Fax: 903-786-9889
Mailing address:
  • Phone: 903-786-3010
  • Fax: 903-786-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number91007
License Number StateTX

VIII. Authorized Official

Name: ALVIN CARROLL SHIELDS JR.
Title or Position: EMS DIRECTOR
Credential:
Phone: 903-786-3010