MEDICARE: HARDIN COUNTY EMERGENCY SERVICE DISTRICT NO 5

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		TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590015398	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316915879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARDIN COUNTY EMERGENCY SERVICE DISTRICT NO 5

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	:	281-397-0007

Provider Business Practice Location Address
First Line	:	711 6TH ST
Second Line	:
City	:	SOUR LAKE
State	:	TX
Zip	:	77659
Country	:	US
Telephone Number	:	409-287-3062
Fax Number	:	409-287-3406

Authorized Official
Title or Position	:	BOARD PRESIDENT
Name	:	GLEN WITHERS
Credential	:
Telephone Number	:	409-287-3062

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	12/05/2011

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Directions to “HARDIN COUNTY EMERGENCY SERVICE DISTRICT NO 5 ” Practice Location

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