Provider Demographics
NPI:1891700753
Name:COUNTY OF WISE
Entity Type:Organization
Organization Name:COUNTY OF WISE
Other - Org Name:WISE COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:PREUNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-627-2002
Mailing Address - Street 1:1101 W ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3304
Mailing Address - Country:US
Mailing Address - Phone:940-627-2002
Mailing Address - Fax:940-627-7521
Practice Address - Street 1:1101 ROSE AVE.
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234
Practice Address - Country:US
Practice Address - Phone:940-627-2002
Practice Address - Fax:940-627-7521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249008341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX514948OtherBC/BS OF TEXAS
TX088232601Medicaid
590005964OtherRAILROAD MEDICARE
TX514948OtherBC/BS OF TEXAS