Provider Demographics
NPI:1801864368
Name:WALLER COUNTY VOLUNTEER EMS, INC
Entity Type:Organization
Organization Name:WALLER COUNTY VOLUNTEER EMS, INC
Other - Org Name:WALLER COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:979-826-6063
Mailing Address - Street 1:1134 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:TX
Mailing Address - Zip Code:77445-4428
Mailing Address - Country:US
Mailing Address - Phone:979-826-6063
Mailing Address - Fax:979-826-0205
Practice Address - Street 1:1134 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445-4428
Practice Address - Country:US
Practice Address - Phone:979-826-6063
Practice Address - Fax:979-826-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3001143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1635839Medicaid
TX000631401Medicaid
LA1635839Medicaid
590011550Medicare ID - Type UnspecifiedRAILROAD
F30342Medicare UPIN