Provider Demographics
NPI:1407964422
Name:MATAGORDA COUNTY EMS I, LLC
Entity Type:Organization
Organization Name:MATAGORDA COUNTY EMS I, LLC
Other - Org Name:MATAGORDA COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-289-0074
Mailing Address - Street 1:PO BOX 22578
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-2578
Mailing Address - Country:US
Mailing Address - Phone:409-812-1017
Mailing Address - Fax:866-206-2306
Practice Address - Street 1:2900 HAMMAN RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-8622
Practice Address - Country:US
Practice Address - Phone:979-244-5568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8000703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB798OtherBC/BS
TX179300201Medicaid
TXAMB480Medicare ID - Type UnspecifiedMEDICARE