Provider Demographics
NPI:1548385586
Name:WEST TEXAS AMBULANCE SERVICE
Entity Type:Organization
Organization Name:WEST TEXAS AMBULANCE SERVICE
Other - Org Name:MICHAEL L SCUDDER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCUDDER
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:432-837-1119
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79831-0338
Mailing Address - Country:US
Mailing Address - Phone:432-837-1119
Mailing Address - Fax:
Practice Address - Street 1:106 E BROWN AVE
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830
Practice Address - Country:US
Practice Address - Phone:432-837-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX022001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000309701Medicaid
TX0005156450OtherAETNA
TX0000513306OtherBLUE CROSS BLUE SHIELD
TX0005156450OtherAETNA