Healthcare Provider Details

I. General information

NPI: 1184981482
Provider Name (Legal Business Name): PECAN GROVE VOLUNTEER FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 PITTS RD
RICHMOND TX
77406-2205
US

IV. Provider business mailing address

PO BOX 691363
HOUSTON TX
77269-1363
US

V. Phone/Fax

Practice location:
  • Phone: 281-341-6677
  • Fax:
Mailing address:
  • Phone: 281-397-0397
  • Fax: 281-397-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State

VIII. Authorized Official

Name: PAUL LEDOUX
Title or Position: FIRE CHIEF
Credential:
Phone: 281-341-6677