Provider Demographics
NPI:1649275256
Name:EAST COKE CO. AMBULANC SRV.
Entity type:Organization
Organization Name:EAST COKE CO. AMBULANC SRV.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-453-2511
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:BRONTE
Mailing Address - State:TX
Mailing Address - Zip Code:76933-0357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 S.WASHINGTON
Practice Address - Street 2:
Practice Address - City:BRONTE
Practice Address - State:TX
Practice Address - Zip Code:76933
Practice Address - Country:US
Practice Address - Phone:325-453-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX041004146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX506277Medicare ID - Type UnspecifiedEAST COKE COUNTY AMB. SRV