=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790507275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BORDEN COUNTY EMERGENCY SQUAD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2024
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E WASSON
-----------------------------------------------------
City | GAIL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-758-1189
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 291
-----------------------------------------------------
City | GAIL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79738-0291
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF/ADMINISTRATOR
-----------------------------------------------------
Name | BOBBY BEENE
-----------------------------------------------------
Credential | ADV. EMT
-----------------------------------------------------
Telephone | 806-758-1189
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333300000X
-----------------------------------------------------
Taxonomy Name | Emergency Response System Companies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------