MEDICARE: BROOKSHIRE PATTISON AREA VOLUNTEER EMERGENCY AMBULANCE CORP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000504752	OTHER	TX	BLUE CROSS BLUE SHIELD
2	H0000504752	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396842019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKSHIRE PATTISON AREA VOLUNTEER EMERGENCY AMBULANCE CORP

Provider Business Mailing Address
First Line	:	PO BOX 908
Second Line	:
City	:	BROOKSHIRE
State	:	TX
Zip	:	77423-0908
Country	:	US
Telephone Number	:	281-375-8500
Fax Number	:	281-934-4866

Provider Business Practice Location Address
First Line	:	911 GRESHAM
Second Line	:
City	:	BROOKSHIRE
State	:	TX
Zip	:	77423
Country	:	US
Telephone Number	:	281-375-8500
Fax Number	:	281-934-4866

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MAXINE PATE
Credential	:
Telephone Number	:	281-375-8500

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	08/22/2020

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Directions to “BROOKSHIRE PATTISON AREA VOLUNTEER EMERGENCY AMBULANCE CORP ” Practice Location

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