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General NPI Number Information
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NPI Number | 1255682001
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Entity Type | Organization
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Legal Business Name | WASHINGTON COUNTY
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 1875 HIGHWAY 290 W
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City | BRENHAM
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State | TX
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Zip | 77833-5217
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Country | US
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Telephone | 979-277-6267
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Fax | 979-277-6270
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Provider Business Mailing Address
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Address Line | 1875 HIGHWAY 290 W
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City | BRENHAM
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State | TX
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Zip | 77833-5217
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Country | US
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Telephone | 979-277-6267
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Fax | 979-277-6270
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Authorized Official
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Title or Position | EMS DIRECTOR
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Name | KEVIN DERAMUS
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Credential |
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Telephone | 979-277-6267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | MW2156974
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License Number State | TX
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