Provider Demographics
NPI:1518012293
Name:MOTLEY COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MOTLEY COUNTY HOSPITAL DISTRICT
Other - Org Name:MOTLEY COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, MOTLEY COUNTY AMBULANCE S
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:806-347-2808
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:MATADOR
Mailing Address - State:TX
Mailing Address - Zip Code:79244-0009
Mailing Address - Country:US
Mailing Address - Phone:806-347-2808
Mailing Address - Fax:
Practice Address - Street 1:1224 MAIN
Practice Address - Street 2:
Practice Address - City:MATADOR
Practice Address - State:TX
Practice Address - Zip Code:79244-0009
Practice Address - Country:US
Practice Address - Phone:806-347-2808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1730013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX502692Medicare ID - Type UnspecifiedMC#