Provider Demographics
NPI:1265539654
Name:NORTHEAST GAINES COUNTY EMERGENCY SERVICE DISTRICT 1
Entity type:Organization
Organization Name:NORTHEAST GAINES COUNTY EMERGENCY SERVICE DISTRICT 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:806-487-6730
Mailing Address - Street 1:RR 1 BOX 125
Mailing Address - Street 2:
Mailing Address - City:SEAGRAVES
Mailing Address - State:TX
Mailing Address - Zip Code:79359-9502
Mailing Address - Country:US
Mailing Address - Phone:806-487-6730
Mailing Address - Fax:806-487-6714
Practice Address - Street 1:1404 AVE E
Practice Address - Street 2:
Practice Address - City:SEAGRAVES
Practice Address - State:TX
Practice Address - Zip Code:79359-9502
Practice Address - Country:US
Practice Address - Phone:806-487-6730
Practice Address - Fax:806-487-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0830023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105909100OtherFIRSTCARE ID #
TX0003204-01Medicaid
TX0003204-01Medicaid