Provider Demographics
NPI:1801843677
Name:CITY-COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:CITY-COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:806-495-1813
Mailing Address - Street 1:608 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:POST
Mailing Address - State:TX
Mailing Address - Zip Code:79356-3629
Mailing Address - Country:US
Mailing Address - Phone:806-495-1813
Mailing Address - Fax:806-495-1195
Practice Address - Street 1:608 W 6TH ST
Practice Address - Street 2:
Practice Address - City:POST
Practice Address - State:TX
Practice Address - Zip Code:79356-3629
Practice Address - Country:US
Practice Address - Phone:806-495-1813
Practice Address - Fax:806-495-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX085001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0864928-01Medicaid
TX102877100OtherFIRST CARE
TX0000504098OtherBLUE CROSS/BLUE SHIELD
504098Medicare ID - Type Unspecified
TX0864928-01Medicaid