MEDICARE: WISE COUNTY EMERGENCY MEDICAL SERVICES

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	249008	TX

General Provider Information

NPI Number	:	1649273376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE COUNTY EMERGENCY MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	400 W WALNUT ST
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-1372
Country	:	US
Telephone Number	:	940-627-2002
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W WALNUT ST
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-1372
Country	:	US
Telephone Number	:	940-627-2002
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CHARLES R DILLARD
Credential	:
Telephone Number	:	940-627-2002

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/22/2020

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Directions to “WISE COUNTY EMERGENCY MEDICAL SERVICES ” Practice Location

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