=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316082993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRIO CANYON EMS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 10/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 WEST 5TH ST.
-----------------------------------------------------
City | LEAKEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78873-0803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-232-5299
-----------------------------------------------------
Fax | 830-232-4317
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 WEST 5TH ST.
-----------------------------------------------------
City | LEAKEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78873-0803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-232-5299
-----------------------------------------------------
Fax | 830-232-4317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DIANNE RODGERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 830-232-5299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 193001
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------