# LIBERTY COUNTY EMERGENCY MEDICAL SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HULL DAISETTA VOL. AMBULANCE SERVICE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336242601
- **Authorized official:** MR. WILLIAM MICHAEL KOEN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (936) 536-3080

## Contact information

- **Practice address:** 114 MAIN ST., DAISETTA, TX 77533
- **Practice address phone:** (936) 536-3080
- **Practice address fax:** (936) 536-6519
- **Mailing address:** PO BOX 351, HULL, TX 77564-0351
- **Mailing address phone:** (936) 536-3080
- **Mailing address fax:** (936) 536-6519

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 146013 | TX | Yes |

## Other

- **Enumeration date:** 09/05/2006
- **Last updated:** 05/24/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000519101 | — | TX |
| 05 | — | 1161942 | — | LA |
| 01 | — | 517216 | BCBS | TX |