Organization
PORT BOLIVAR VFN & EMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN LAAKE (AUTHORIZED AGENT)
(281) 397-0397
Entity
Organization
Contact information
Practice address
1806 LOOP 108, PORT BOLIVAR, TX 77650
(409) 684-1984
(409) 684-1984
Mailing address
PO BOX 691363, HOUSTON, TX 77269-1363
(281) 397-0397
(281) 397-0007
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000555501
—
TX
05
—
1635626
—
LA
01
—
P00083263
RAILROAD MEDICARE
—
Enumeration date
03/10/2006
Last updated
07/02/2008
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