=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720113798
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED MEDEVAC SOLUTIONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 10/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 STEARMAN DR
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78628-2322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-366-8126
-----------------------------------------------------
Fax | 866-635-9867
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2491
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78627-2491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-247-7441
-----------------------------------------------------
Fax | 866-635-9867
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT CEO
-----------------------------------------------------
Name | MRS. DANIELLE SUE WILSON
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 254-247-7441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 1000905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1000905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number | 1000905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 1000905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 3418M1120X
-----------------------------------------------------
Taxonomy Name | Military or U.S. Coast Guard Air Transport Ambulance
-----------------------------------------------------
License Number | 1000905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 3418M1110X
-----------------------------------------------------
Taxonomy Name | Military or U.S. Coast Guard Ground Transport Ambulance
-----------------------------------------------------
License Number | 1000905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number | 1000905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 3416A0800X
-----------------------------------------------------
Taxonomy Name | Air Ambulance
-----------------------------------------------------
License Number | 1000905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------