Provider Demographics
NPI:1457481350
Name:JOLLYVILLE VOLUNTEER FIRE DEPT
Entity Type:Organization
Organization Name:JOLLYVILLE VOLUNTEER FIRE DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-397-0397
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:281-397-0007
Practice Address - Street 1:12507 MELLOW MEADOW DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1827
Practice Address - Country:US
Practice Address - Phone:512-258-1038
Practice Address - Fax:512-258-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800141146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty