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General NPI Number Information
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NPI Number | 1073689428
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Entity Type | Organization
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Legal Business Name | CITY OF EDNA VOLUNTEER AMBULANCE SERVICE
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 N ALLEN ST
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City | EDNA
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State | TX
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Zip | 77957-2642
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Country | US
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Telephone | 361-782-3159
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Fax | 361-782-7382
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Provider Business Mailing Address
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Address Line | 126 W MAIN ST
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City | EDNA
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State | TX
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Zip | 77957-2725
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Country | US
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Telephone | 361-782-3159
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Fax | 361-782-7382
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Authorized Official
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Title or Position | EMS DIRECTOR
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Name | MR. LOYD MARSHALL CHASE JR.
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Credential |
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Telephone | 361-782-3159
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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 | 120007
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License Number State | TX
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