MEDICARE: EDEN EMS INC

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	1000525	TX

General Provider Information

NPI Number	:	1477855013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN EMS INC

Provider Business Mailing Address
First Line	:	PO BOX 268
Second Line	:
City	:	EDEN
State	:	TX
Zip	:	76837-0268
Country	:	US
Telephone Number	:	325-656-4853
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 GORDON ST
Second Line	:
City	:	EDEN
State	:	TX
Zip	:	76837-0000
Country	:	US
Telephone Number	:	325-656-4853
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICKY THOMAS
Credential	:
Telephone Number	:	325-656-4853

Provider Enumeration Date	:	12/02/2010
Last Update Date	:	12/02/2010

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Directions to “EDEN EMS INC ” Practice Location

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