=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376576553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REDDS AMBULANCE SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 05/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5655 EASTEX FWY SUITE M-6A
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77706-6923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-899-2644
-----------------------------------------------------
Fax | 409-899-2645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 23120
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77720-3120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-899-2644
-----------------------------------------------------
Fax | 409-899-2645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SERVICE DIRECTOR
-----------------------------------------------------
Name | MR. RICHARD FONTENOT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-855-6311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 800158
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------