MEDICARE: VILLAGE OF LAKE TANGLEWOOD TEXAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	191005	TX

General Provider Information

NPI Number	:	1063480523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF LAKE TANGLEWOOD TEXAS

Provider Business Mailing Address
First Line	:	PO BOX 691363
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77269-1363
Country	:	US
Telephone Number	:	281-397-0397
Fax Number	:	281-397-6934

Provider Business Practice Location Address
First Line	:	201 N SHORE DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79118-9391
Country	:	US
Telephone Number	:	806-622-8711
Fax Number	:	806-367-6240

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MR. ROBERT JACK HULSEY
Credential	:	NREMTP
Telephone Number	:	806-206-4684

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	09/22/2010

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Directions to “VILLAGE OF LAKE TANGLEWOOD TEXAS ” Practice Location

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