=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841276219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAIRFIELD AMBULANCE SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2005
-----------------------------------------------------
Last Update Date | 04/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 W COMMERCE ST
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75840-1426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-389-6511
-----------------------------------------------------
Fax | 903-389-9731
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 W COMMERCE ST
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75840-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-389-6511
-----------------------------------------------------
Fax | 903-389-9731
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. IGNACIO W PEREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-389-6511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 081006
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------