Provider Demographics
NPI:1942221312
Name:COUNTY OF CROCKETT
Entity Type:Organization
Organization Name:COUNTY OF CROCKETT
Other - Org Name:CROCKETT COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-392-3404
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:OZONA
Mailing Address - State:TX
Mailing Address - Zip Code:76943-0577
Mailing Address - Country:US
Mailing Address - Phone:325-392-3404
Mailing Address - Fax:325-392-3404
Practice Address - Street 1:105 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:OZONA
Practice Address - State:TX
Practice Address - Zip Code:76943
Practice Address - Country:US
Practice Address - Phone:325-392-3404
Practice Address - Fax:325-392-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX530013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086576801Medicaid
TX504706OtherBC/BS OF TEXAS
TX086576801Medicaid
TX590010258Medicare PIN