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General NPI Number Information
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NPI Number | 1174538011
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Entity Type | Organization
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Legal Business Name | EDGECLIFF VILLAGE EMS
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 1605 EDGECLIFF RD
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City | FORT WORTH
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State | TX
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Zip | 76134-1121
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Country | US
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Telephone | 817-293-4313
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Fax | 817-293-4660
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Provider Business Mailing Address
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Address Line | 1605 EDGECLIFF RD
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City | FORT WORTH
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State | TX
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Zip | 76134-1121
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Country | US
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Telephone | 817-293-4313
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Fax | 817-293-4660
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Authorized Official
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Title or Position | EMS ADMINISTRATOR
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Name | CHRISTOPHER YOUNG
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Credential |
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Telephone | 817-293-4313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 220001
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License Number State | TX
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