Provider Demographics
NPI:1053332429
Name:GOLIAD COUNTY
Entity Type:Organization
Organization Name:GOLIAD COUNTY
Other - Org Name:GOLIAD COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-645-8191
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:GOLIAD
Mailing Address - State:TX
Mailing Address - Zip Code:77963-0938
Mailing Address - Country:US
Mailing Address - Phone:361-645-8191
Mailing Address - Fax:361-645-1244
Practice Address - Street 1:338 WEST END
Practice Address - Street 2:
Practice Address - City:GOLIAD
Practice Address - State:TX
Practice Address - Zip Code:77963
Practice Address - Country:US
Practice Address - Phone:361-645-8191
Practice Address - Fax:361-645-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
TX880023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX506821OtherBC/BS OF TEXAS
TX1053332429Medicaid
TXP00169285Medicare PIN
TX506821Medicare PIN