Provider Demographics
NPI:1295755106
Name:PRESTON VOLUNTEER EMERGENCY SERVICE, INC
Entity type:Organization
Organization Name:PRESTON VOLUNTEER EMERGENCY SERVICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:903-786-3010
Mailing Address - Street 1:14691 HIGHWAY 120 N
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-3348
Mailing Address - Country:US
Mailing Address - Phone:903-786-3010
Mailing Address - Fax:903-786-9889
Practice Address - Street 1:14691 HIGHWAY 120 N
Practice Address - Street 2:
Practice Address - City:POTTSBORO
Practice Address - State:TX
Practice Address - Zip Code:75076-3348
Practice Address - Country:US
Practice Address - Phone:903-786-3010
Practice Address - Fax:903-786-9889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTON VOLUNTEER EMERGENCY SERVICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-21
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91007341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB536OtherBC/BS OF TEXAS
TXAMB536OtherBC/BS
590013818OtherRAILROAD MEDICARE
TX148444601Medicaid
590013818OtherRAILROAD MEDICARE