Provider Demographics
NPI:1487637831
Name:GROOM VOLUNTEER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:GROOM VOLUNTEER AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-248-7929
Mailing Address - Street 1:8300 BISSONNET ST
Mailing Address - Street 2:STE 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3900
Mailing Address - Country:US
Mailing Address - Phone:713-773-4355
Mailing Address - Fax:713-773-4363
Practice Address - Street 1:203 BROADWAY
Practice Address - Street 2:
Practice Address - City:GROOM
Practice Address - State:TX
Practice Address - Zip Code:79039-0111
Practice Address - Country:US
Practice Address - Phone:806-248-7929
Practice Address - Fax:806-248-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX033001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX501477Medicare ID - Type Unspecified