=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174556864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST CARLISLE VOLUNTEER FIRE DEPARTMENT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 07/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 INLER AVE
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79416-9505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-797-0412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 98044
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79499-8044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-797-0412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF, DIRECTOR EMS
-----------------------------------------------------
Name | TIM SMITH
-----------------------------------------------------
Credential | RN, EMT-P
-----------------------------------------------------
Telephone | 806-797-0412
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | 152018
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------