Provider Demographics
NPI:1619972270
Name:WAYSIDE EMERGENCY TEAM, INC.
Entity Type:Organization
Organization Name:WAYSIDE EMERGENCY TEAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-764-3354
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:WAYSIDE
Mailing Address - State:TX
Mailing Address - Zip Code:79094-0131
Mailing Address - Country:US
Mailing Address - Phone:806-764-3354
Mailing Address - Fax:806-764-3356
Practice Address - Street 1:3407 CO RD 5
Practice Address - Street 2:
Practice Address - City:WAYSIDE
Practice Address - State:TX
Practice Address - Zip Code:79094-0131
Practice Address - Country:US
Practice Address - Phone:806-764-3354
Practice Address - Fax:806-764-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0060023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000743701Medicaid
TXAMB782OtherBCBS
TXAMB111Medicare PIN