Provider Demographics
NPI:1942328018
Name:JEWETT EMS INC
Entity Type:Organization
Organization Name:JEWETT EMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:NREMTP
Authorized Official - Phone:903-626-4958
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:JEWETT
Mailing Address - State:TX
Mailing Address - Zip Code:75846-0491
Mailing Address - Country:US
Mailing Address - Phone:903-626-4958
Mailing Address - Fax:903-626-6788
Practice Address - Street 1:613 W. MEXIA HWY
Practice Address - Street 2:
Practice Address - City:JEWETT
Practice Address - State:TX
Practice Address - Zip Code:75846-0491
Practice Address - Country:US
Practice Address - Phone:903-626-4958
Practice Address - Fax:903-626-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1450053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0005274-01Medicaid
TX517518Medicare PIN