Provider Demographics
NPI:1346762382
Name:POSSUM KINGDOM LAKE VOLUNTEER EMS INC
Entity Type:Organization
Organization Name:POSSUM KINGDOM LAKE VOLUNTEER EMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST EMS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ULBRICH
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:940-452-5933
Mailing Address - Street 1:344 N FM 2353 UNIT A
Mailing Address - Street 2:
Mailing Address - City:GRAFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76449-1943
Mailing Address - Country:US
Mailing Address - Phone:940-452-5933
Mailing Address - Fax:940-779-2003
Practice Address - Street 1:358 N FM 2353
Practice Address - Street 2:
Practice Address - City:GRAFORD
Practice Address - State:TX
Practice Address - Zip Code:76449
Practice Address - Country:US
Practice Address - Phone:940-779-2390
Practice Address - Fax:940-779-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies