MEDICARE: WALLER COUNTY VOLUNTEER 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	300114	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801864368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALLER COUNTY VOLUNTEER EMS, INC

Provider Business Mailing Address
First Line	:	1134 AUSTIN ST
Second Line	:
City	:	HEMPSTEAD
State	:	TX
Zip	:	77445-4428
Country	:	US
Telephone Number	:	979-826-6063
Fax Number	:	979-826-0205

Provider Business Practice Location Address
First Line	:	1134 AUSTIN ST
Second Line	:
City	:	HEMPSTEAD
State	:	TX
Zip	:	77445-4428
Country	:	US
Telephone Number	:	979-826-6063
Fax Number	:	979-826-0205

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ARCHIE HASHAW JR.
Credential	:
Telephone Number	:	979-826-6063

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	05/07/2014

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