Provider Demographics
NPI:1639206899
Name:MIMS VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:MIMS VOLUNTEER FIRE DEPARTMENT
Other - Org Name:MIMS VFD & AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-755-4112
Mailing Address - Street 1:12728 FM 729
Mailing Address - Street 2:
Mailing Address - City:AVINGER
Mailing Address - State:TX
Mailing Address - Zip Code:75630-8470
Mailing Address - Country:US
Mailing Address - Phone:903-755-4112
Mailing Address - Fax:903-755-3219
Practice Address - Street 1:12728 FM 729
Practice Address - Street 2:
Practice Address - City:AVINGER
Practice Address - State:TX
Practice Address - Zip Code:75630-8470
Practice Address - Country:US
Practice Address - Phone:903-755-4112
Practice Address - Fax:903-755-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3001613416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000457-01Medicaid
TX0000457-01Medicaid