Provider Demographics
NPI:1386627685
Name:WHITE DEER VOLUNTEER EMS
Entity Type:Organization
Organization Name:WHITE DEER VOLUNTEER EMS
Other - Org Name:WHITE DEER EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF WHITE DEER VOLUNTEER EM
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-PARAMEDIC
Authorized Official - Phone:806-676-7610
Mailing Address - Street 1:P.O. BOX 366
Mailing Address - Street 2:STE 205
Mailing Address - City:WHITE DEER
Mailing Address - State:TX
Mailing Address - Zip Code:79097-0366
Mailing Address - Country:US
Mailing Address - Phone:806-883-2288
Mailing Address - Fax:806-883-2008
Practice Address - Street 1:309 W. 2ND STREET
Practice Address - Street 2:
Practice Address - City:WHITE DEER
Practice Address - State:TX
Practice Address - Zip Code:79097-0366
Practice Address - Country:US
Practice Address - Phone:806-883-2288
Practice Address - Fax:806-883-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX033004341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000530801Medicaid
TX000530801Medicaid