Basic Information
| Provider Information | |||||||||
| NPI: | 1255464392 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STONEWALL COUNTY AMBULANCE SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 457 | ||||||||
| Address2: | |||||||||
| City: | ASPERMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795020457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9409893551 | ||||||||
| FaxNumber: | 9409893395 | ||||||||
| Practice Location | |||||||||
| Address1: | 821 N BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | ASPERMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795022029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9409893551 | ||||||||
| FaxNumber: | 9409893395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 08/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | HEIDENHEIMER | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | EMS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9409893551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 217003 | TX | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | AMB501 | 01 | TX | BLUE CROSS BLUE SHEILD | OTHER | P00227345 | 01 | TX | RAILROAD MEDICARE | OTHER | 1510075-01 | 05 | TX | MEDICAID |