Provider Demographics
NPI:1790780252
Name:WEST COKE COUNTY EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:WEST COKE COUNTY EMERGENCY MEDICAL SERVICE
Other - Org Name:WEST COKE COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-224-3047
Mailing Address - Street 1:PO BOX 691363
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-1363
Mailing Address - Country:US
Mailing Address - Phone:281-397-0397
Mailing Address - Fax:281-397-6934
Practice Address - Street 1:801 NORTH HWY 208
Practice Address - Street 2:
Practice Address - City:ROBERT LEE
Practice Address - State:TX
Practice Address - Zip Code:76945
Practice Address - Country:US
Practice Address - Phone:325-224-3047
Practice Address - Fax:325-224-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX041002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1567448-01Medicaid
TNAMB253Medicare ID - Type UnspecifiedAMBULANCE SERVICE