Provider Demographics
NPI:1073689428
Name:CITY OF EDNA VOLUNTEER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:CITY OF EDNA VOLUNTEER AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOYD
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:361-782-3159
Mailing Address - Street 1:126 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-2725
Mailing Address - Country:US
Mailing Address - Phone:361-782-3159
Mailing Address - Fax:361-782-7382
Practice Address - Street 1:103 N ALLEN ST
Practice Address - Street 2:
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-2642
Practice Address - Country:US
Practice Address - Phone:361-782-3159
Practice Address - Fax:361-782-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1200073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX505031Medicare ID - Type UnspecifiedPROVIDER NUMBER