Provider Demographics
NPI:1750373577
Name:GONZALES VOLUNTEER AMBULANCE CORPS.
Entity type:Organization
Organization Name:GONZALES VOLUNTEER AMBULANCE CORPS.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:830-672-7675
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:1703 ST. JOSEPH ST.
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-0062
Mailing Address - Country:US
Mailing Address - Phone:830-672-7675
Mailing Address - Fax:830-672-2222
Practice Address - Street 1:1703 N SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-2331
Practice Address - Country:US
Practice Address - Phone:830-672-7675
Practice Address - Fax:830-672-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0890013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00151720OtherRAILROAD MEDICARE
TXP00151720OtherRAILROAD MEDICARE