MEDICARE: STONEWALL COUNTY AMBULANCE SERVICE

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	217003	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00227345	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AMB501	OTHER	TX	BLUE CROSS BLUE SHEILD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255464392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEWALL COUNTY AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:
City	:	ASPERMONT
State	:	TX
Zip	:	79502-0457
Country	:	US
Telephone Number	:	940-989-3551
Fax Number	:	940-989-3395

Provider Business Practice Location Address
First Line	:	821 N BROADWAY ST
Second Line	:
City	:	ASPERMONT
State	:	TX
Zip	:	79502-2029
Country	:	US
Telephone Number	:	940-989-3551
Fax Number	:	940-989-3395

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	TAMMY KAY HEIDENHEIMER
Credential	:
Telephone Number	:	940-989-3551

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/04/2015

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Directions to “STONEWALL COUNTY AMBULANCE SERVICE ” Practice Location

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