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General NPI Number Information
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NPI Number | 1649470543
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Entity Type | Organization
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Legal Business Name | EVENING STAR AMBULANCE SERVICE, INC.
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 1108 ZANDERSON AVE
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City | JOURDANTON
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State | TX
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Zip | 78026-3534
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Country | US
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Telephone | 830-569-5911
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 HOSPITAL BLVD UNIT 2
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City | FLORESVILLE
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State | TX
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Zip | 78114-2731
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Country | US
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Telephone | 830-569-9111
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JESSIE JAMES DAVIS
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Credential |
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Telephone | 210-669-5846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 1000033
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License Number State | TX
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