Provider Demographics
NPI:1083733703
Name:COUNTY OF KENT
Entity Type:Organization
Organization Name:COUNTY OF KENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:806-269-3111
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:JAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79528-0041
Mailing Address - Country:US
Mailing Address - Phone:806-237-2582
Mailing Address - Fax:806-237-2582
Practice Address - Street 1:831 S. MAIN
Practice Address - Street 2:
Practice Address - City:JAYTON
Practice Address - State:TX
Practice Address - Zip Code:79528-0185
Practice Address - Country:US
Practice Address - Phone:806-237-2582
Practice Address - Fax:806-237-2582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1320013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0864704-01Medicaid
TX503940OtherBC/BS
TX503940Medicare UPIN
TX503940OtherBC/BS