Provider Demographics
NPI:1689713729
Name:WEST VOLUNTARY AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:WEST VOLUNTARY AMBULANCE ASSOCIATION
Other - Org Name:WEST VOLUNTEER EMERGENCY MEDICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:254-826-3779
Mailing Address - Street 1:411 MEADOW DR
Mailing Address - Street 2:P.O. BOX 461
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-1033
Mailing Address - Country:US
Mailing Address - Phone:254-826-3779
Mailing Address - Fax:254-826-3149
Practice Address - Street 1:411 MEADOW DR
Practice Address - Street 2:BOX 461
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-1033
Practice Address - Country:US
Practice Address - Phone:254-826-3779
Practice Address - Fax:254-826-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3000393416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX509159Medicare ID - Type UnspecifiedPROVIDER ID #