Provider Demographics
NPI:1255464392
Name:STONEWALL COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:STONEWALL COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HEIDENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-989-3551
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:ASPERMONT
Mailing Address - State:TX
Mailing Address - Zip Code:79502-0457
Mailing Address - Country:US
Mailing Address - Phone:940-989-3551
Mailing Address - Fax:940-989-3395
Practice Address - Street 1:821 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ASPERMONT
Practice Address - State:TX
Practice Address - Zip Code:79502-2029
Practice Address - Country:US
Practice Address - Phone:940-989-3551
Practice Address - Fax:940-989-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2170033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB501OtherBLUE CROSS BLUE SHEILD
TXP00227345OtherRAILROAD MEDICARE
TX1510075-01Medicaid
TX1510075-01Medicaid