Provider Demographics
NPI:1417007188
Name:EAST BERNARD EMERGENCY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:EAST BERNARD EMERGENCY MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR OF EMS
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JASEK
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC BILLING
Authorized Official - Phone:979-335-6644
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:103 MAIN ST
Mailing Address - City:EAST BERNARD
Mailing Address - State:TX
Mailing Address - Zip Code:77435-0612
Mailing Address - Country:US
Mailing Address - Phone:979-335-6644
Mailing Address - Fax:979-335-6544
Practice Address - Street 1:103 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST BERNARD
Practice Address - State:TX
Practice Address - Zip Code:77435-0612
Practice Address - Country:US
Practice Address - Phone:979-335-6644
Practice Address - Fax:979-335-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241004251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX507684Medicare ID - Type UnspecifiedPROVIDER NUMBER