=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801864368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALLER COUNTY VOLUNTEER EMS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2006
-----------------------------------------------------
Last Update Date | 05/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1134 AUSTIN ST
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77445-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-826-6063
-----------------------------------------------------
Fax | 979-826-0205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1134 AUSTIN ST
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77445-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-826-6063
-----------------------------------------------------
Fax | 979-826-0205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ARCHIE HASHAW JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 979-826-6063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 300114
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------