MEDICARE: PERMIAN BASIN AMBULANCE 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	341600000X	Ambulance

General Provider Information

NPI Number	:	1780609511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERMIAN BASIN AMBULANCE INC.

Provider Business Mailing Address
First Line	:	3711 BRAZOS AVE
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79764-6521
Country	:	US
Telephone Number	:	432-550-9410
Fax Number	:	432-550-9400

Provider Business Practice Location Address
First Line	:	3711 BRAZOS AVE
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79764-6521
Country	:	US
Telephone Number	:	432-550-9410
Fax Number	:	432-550-9400

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	KRISENDA K CRISWELL
Credential	:	EMT-P
Telephone Number	:	432-550-9410

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/25/2013

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