Provider Demographics
NPI:1336210905
Name:CITY OF BALMORHEA
Entity Type:Organization
Organization Name:CITY OF BALMORHEA
Other - Org Name:BALMORHEA VOLUNTEER EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:432-375-2307
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:BALMORHEA
Mailing Address - State:TX
Mailing Address - Zip Code:79718
Mailing Address - Country:US
Mailing Address - Phone:432-375-2307
Mailing Address - Fax:432-375-2200
Practice Address - Street 1:310 S SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:BALMORHEA
Practice Address - State:TX
Practice Address - Zip Code:79718
Practice Address - Country:US
Practice Address - Phone:432-375-2307
Practice Address - Fax:432-375-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1950033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000063001Medicaid
TX000063001Medicaid