Provider Demographics
NPI:1821174988
Name:SILVERTON VOLUNTEER AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:SILVERTON VOLUNTEER AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-823-2134
Mailing Address - Street 1:8300 BISSONNET ST
Mailing Address - Street 2:STE. 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3900
Mailing Address - Country:US
Mailing Address - Phone:713-773-4355
Mailing Address - Fax:713-773-4363
Practice Address - Street 1:705 LONESTAR
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:TX
Practice Address - Zip Code:79257
Practice Address - Country:US
Practice Address - Phone:806-823-2134
Practice Address - Fax:806-823-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX023002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086414201Medicaid
TX503630Medicare ID - Type Unspecified