=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467576959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPICEWOOD VOLUNTEER FIRE DEPARTMENT EMERGENCY MEDICAL SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 01/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9805 HWY 71 E
-----------------------------------------------------
City | SPICEWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78669-4081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-693-7136
-----------------------------------------------------
Fax | 830-798-0446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 691363
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77269-1363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-397-0397
-----------------------------------------------------
Fax | 281-397-6934
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | DONNA M WALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 830-693-4726
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146N00000X
-----------------------------------------------------
Taxonomy Name | Basic Emergency Medical Technician
-----------------------------------------------------
License Number | 027009
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 027009
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------