=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235219114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCGREGOR VOLUNTEER EMERGENCY MEDICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 04/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 S. MAIN ST.
-----------------------------------------------------
City | MCGREGOR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76657-0237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-840-2528
-----------------------------------------------------
Fax | 254-840-4362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 237
-----------------------------------------------------
City | MCGREGOR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76657-0237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-840-2528
-----------------------------------------------------
Fax | 254-840-4362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | MR. ROBERT M TARBET JR.
-----------------------------------------------------
Credential | PARAMEDIC
-----------------------------------------------------
Telephone | 254-840-2528
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 155015
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------