Provider Demographics
NPI:1790867265
Name:MIAMI VOLUNTEER EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:MIAMI VOLUNTEER EMERGENCY MEDICAL SERVICE
Other - Org Name:MIAMI VOLUNTEER EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-868-3761
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:TX
Mailing Address - Zip Code:79059-0007
Mailing Address - Country:US
Mailing Address - Phone:806-868-3761
Mailing Address - Fax:806-278-8051
Practice Address - Street 1:214 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:TX
Practice Address - Zip Code:79059
Practice Address - Country:US
Practice Address - Phone:806-868-3761
Practice Address - Fax:806-868-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1970013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000497001Medicaid
TX197001OtherSTATE EMS ID NUMBER
TX197001OtherSTATE EMS ID NUMBER