=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679594568
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENDALL COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 05/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1175 N MAIN ST
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-249-3721
-----------------------------------------------------
Fax | 830-249-7936
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7900 NW 154TH ST STE 201
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-5816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-987-6179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS DIRECTOR
-----------------------------------------------------
Name | BRIAN WEBB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 830-249-3721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 130001
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------