Provider Demographics
NPI:1689017592
Name:IMPEL AMBULANCE SERVICE, INC
Entity Type:Organization
Organization Name:IMPEL AMBULANCE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-918-4771
Mailing Address - Street 1:PO BOX 6607
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-6607
Mailing Address - Country:US
Mailing Address - Phone:430-625-7050
Mailing Address - Fax:430-625-7090
Practice Address - Street 1:521 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6434
Practice Address - Country:US
Practice Address - Phone:430-625-7050
Practice Address - Fax:430-625-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport