Provider Demographics
NPI:1558411728
Name:CITIZENS EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:CITIZENS EMERGENCY MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:NICOLLE
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:325-439-5150
Mailing Address - Street 1:PO BOX 1556
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:TX
Mailing Address - Zip Code:79510-1556
Mailing Address - Country:US
Mailing Address - Phone:325-893-5754
Mailing Address - Fax:325-893-4127
Practice Address - Street 1:815 SOUTH 2ND
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:TX
Practice Address - Zip Code:79510
Practice Address - Country:US
Practice Address - Phone:325-893-5754
Practice Address - Fax:325-893-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX030001146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX505676Medicare ID - Type Unspecified