Provider Demographics
NPI:1568689461
Name:LABELLE FANNETT VOLUNTEER FIRE
Entity Type:Organization
Organization Name:LABELLE FANNETT VOLUNTEER FIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-794-1441
Mailing Address - Street 1:2800 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-5137
Mailing Address - Country:US
Mailing Address - Phone:888-483-9893
Mailing Address - Fax:936-334-9861
Practice Address - Street 1:18769 FM 365 RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-8761
Practice Address - Country:US
Practice Address - Phone:409-794-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123012341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX515710OtherBC/BS
TX000471501Medicaid
TX515710Medicare PIN