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General NPI Number Information
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NPI Number | 1104137322
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Entity Type | Organization
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Legal Business Name | POWELL PROFESSIONAL OF WEST TEXAS, LLC
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 1501 4TH ST
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City | BROWNWOOD
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State | TX
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Zip | 76801-4430
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Country | US
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Telephone | 325-643-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 1239 BOWIE ST
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City | COLUMBUS
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State | TX
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Zip | 78934-2343
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Country | US
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Telephone | 979-733-0010
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Fax | 979-733-0051
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Authorized Official
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Title or Position | MEMBER
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Name | RICKY LEE POWELL
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Credential |
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Telephone | 979-733-0010
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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 | 100469
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License Number State | TX
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