Provider Demographics
NPI:1063480523
Name:VILLAGE OF LAKE TANGLEWOOD TEXAS
Entity Type:Organization
Organization Name:VILLAGE OF LAKE TANGLEWOOD TEXAS
Other - Org Name:LAKE TANGLEWOOD EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:HULSEY
Authorized Official - Suffix:
Authorized Official - Credentials:NREMTP
Authorized Official - Phone:806-206-4684
Mailing Address - Street 1:PO BOX 691363
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-1363
Mailing Address - Country:US
Mailing Address - Phone:281-397-0397
Mailing Address - Fax:281-397-6934
Practice Address - Street 1:201 N SHORE DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-9391
Practice Address - Country:US
Practice Address - Phone:806-622-8711
Practice Address - Fax:806-367-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1910053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB749Medicare PIN