Provider Demographics
NPI:1245234855
Name:TIMPSON VOLUNTEER AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:TIMPSON VOLUNTEER AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-LP/CRTT
Authorized Official - Phone:936-554-0988
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 1:159 AUSTIN ST.
Practice Address - Street 2:
Practice Address - City:TIMPSON
Practice Address - State:TX
Practice Address - Zip Code:75975
Practice Address - Country:US
Practice Address - Phone:936-254-2375
Practice Address - Fax:936-254-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210004341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590014118OtherRAILROAD
TX000084601Medicaid
TX505797OtherBCBS TEXAS
TX000084601Medicaid