Provider Demographics
NPI:1750448379
Name:STOCKDALE VOLUNTEER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:STOCKDALE VOLUNTEER AMBULANCE SERVICE
Other - Org Name:STOCKDALE EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:830-996-3087
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:STOCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:78160-0341
Mailing Address - Country:US
Mailing Address - Phone:830-996-3087
Mailing Address - Fax:210-653-8168
Practice Address - Street 1:111 HWY 123 NORTH
Practice Address - Street 2:
Practice Address - City:STOCKDALE
Practice Address - State:TX
Practice Address - Zip Code:78160
Practice Address - Country:US
Practice Address - Phone:830-996-3087
Practice Address - Fax:210-653-8168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2470043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086525501Medicaid
TX504301OtherBCFED
TX590008248OtherRAILROAD MCR
TX086525501OtherSUPERIOR
TX086525501OtherCOMMUNITY FIRST
TX504301OtherBCBS
TX086525501Medicaid
TX504301Medicare ID - Type UnspecifiedMEDICARE