MEDICARE: EDGECLIFF VILLAGE EMS

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	341600000X	Ambulance	220001	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	508856	OTHER	TX	BC/BS OF TEXAS

General Provider Information

NPI Number	:	1174538011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGECLIFF VILLAGE EMS

Provider Business Mailing Address
First Line	:	1605 EDGECLIFF RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-1121
Country	:	US
Telephone Number	:	817-293-4313
Fax Number	:	817-293-4660

Provider Business Practice Location Address
First Line	:	1605 EDGECLIFF RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-1121
Country	:	US
Telephone Number	:	817-293-4313
Fax Number	:	817-293-4660

Authorized Official
Title or Position	:	EMS ADMINISTRATOR
Name	:	CHRISTOPHER YOUNG
Credential	:
Telephone Number	:	817-293-4313

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	12/10/2007

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Directions to “EDGECLIFF VILLAGE EMS ” Practice Location

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