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General NPI Number Information
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NPI Number | 1750448379
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Entity Type | Organization
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Legal Business Name | STOCKDALE VOLUNTEER AMBULANCE SERVICE
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 111 HWY 123 NORTH
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City | STOCKDALE
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State | TX
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Zip | 78160
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Country | US
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Telephone | 830-996-3087
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Fax | 210-653-8168
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Provider Business Mailing Address
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Address Line | PO BOX 341
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City | STOCKDALE
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State | TX
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Zip | 78160-0341
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Country | US
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Telephone | 830-996-3087
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Fax | 210-653-8168
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID RICE
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Credential | EMT
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Telephone | 830-996-3087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 247004
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License Number State | TX
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