Provider Demographics
NPI:1477577245
Name:BULVERDE-SPRING BRANCH EMS
Entity Type:Organization
Organization Name:BULVERDE-SPRING BRANCH EMS
Other - Org Name:BULVERDE-SPRING BRANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-228-4501
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-0038
Mailing Address - Country:US
Mailing Address - Phone:830-228-4501
Mailing Address - Fax:830-228-4503
Practice Address - Street 1:353 RODEO DR
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070
Practice Address - Country:US
Practice Address - Phone:830-228-4501
Practice Address - Fax:830-228-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46003341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590001497OtherRAILROAD MEDICARE
TX507115OtherBC/BS OF TEXAS
TX000157001Medicaid
590001497OtherRAILROAD MEDICARE