Provider Demographics
NPI:1073556684
Name:BLANCO VOLUNTEER AMBULANCE CORP. INC.
Entity Type:Organization
Organization Name:BLANCO VOLUNTEER AMBULANCE CORP. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, LP
Authorized Official - Phone:830-833-5239
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-0632
Mailing Address - Country:US
Mailing Address - Phone:830-833-5239
Mailing Address - Fax:830-833-1032
Practice Address - Street 1:607 CHANDLER
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606
Practice Address - Country:US
Practice Address - Phone:830-833-5239
Practice Address - Fax:830-833-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016001341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000120801Medicaid
TX506654Medicare PIN