Provider Demographics
NPI:1306862586
Name:GROVETON EMERGENCY MEDICAL SERVICE INC
Entity Type:Organization
Organization Name:GROVETON EMERGENCY MEDICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-642-1212
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 1:200 W SECOND ST
Practice Address - Street 2:
Practice Address - City:GROVETON
Practice Address - State:TX
Practice Address - Zip Code:75845-7700
Practice Address - Country:US
Practice Address - Phone:936-642-1212
Practice Address - Fax:936-642-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228003341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140465901Medicaid
TX590014557OtherRAILROAD MEDICARE
TX140465901Medicaid
TX140465901Medicaid