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General NPI Number Information
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NPI Number | 1063480523
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Entity Type | Organization
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Legal Business Name | VILLAGE OF LAKE TANGLEWOOD TEXAS
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 201 N SHORE DR
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City | AMARILLO
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State | TX
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Zip | 79118-9391
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Country | US
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Telephone | 806-622-8711
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Fax | 806-367-6240
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Provider Business Mailing Address
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Address Line | PO BOX 691363
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City | HOUSTON
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State | TX
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Zip | 77269-1363
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Country | US
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Telephone | 281-397-0397
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Fax | 281-397-6934
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Authorized Official
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Title or Position | FIRE CHIEF
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Name | MR. ROBERT JACK HULSEY
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Credential | NREMTP
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Telephone | 806-206-4684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 191005
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License Number State | TX
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