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General NPI Number Information
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NPI Number | 1760486351
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Entity Type | Organization
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Legal Business Name | LIPAN AMBULANCE SERVICE
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 204 E LIPAN DR
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City | LIPAN
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State | TX
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Zip | 76462-2206
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Country | US
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Telephone | 903-473-0927
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Fax | 832-877-5040
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Provider Business Mailing Address
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Address Line | PO BOX 277
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City | LIPAN
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State | TX
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Zip | 76462-0277
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Country | US
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Telephone | 903-473-0927
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Fax | 832-877-5040
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Authorized Official
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Title or Position | BILLING MGR
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Name | MASCHA TAYLOR
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Credential | REG MA
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Telephone | 903-473-0927
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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 | 111003
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License Number State | TX
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