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General NPI Number Information
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NPI Number | 1922363233
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Entity Type | Individual
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Provider Name | RODNEY KEITH TIDWELL PARAMEDIC
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Gender | Male
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 608 W 6TH ST
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City | POST
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State | TX
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Zip | 79356-3629
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Country | US
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Telephone | 806-495-1813
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Fax | 806-495-1195
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Provider Business Mailing Address
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Address Line | 804 W 14TH ST
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City | POST
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State | TX
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Zip | 79356-2104
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Country | US
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Telephone | 806-620-0960
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Fax | 806-495-1195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 139307
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License Number State | TX
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