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Organization

FAYETTE COUNTY

Active
Other names
FAYETTE COUNTY EMERGENCY MEDICAL SERVICES
Organization subpart
No

Provider details

NPI number
Authorized official
JOSHUA P VANDEVER (EMS DIRECTOR)
(979) 968-8991
Entity
Organization

Contact information

Practice address
1721 VON MINDEN RD, LA GRANGE, TX 78945-2400
(979) 968-8991
(979) 968-9488
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-8642

Taxonomy

Speciality
Code
Description
License number
State
341600000X
Ambulance
75001
TX
3416L0300X
Land Ambulance
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
086425801
TX
01
503683
BC/BS OF TEXAS
TX
01
590900060
RAILROAD MEDICARE
01
=========
TRICARE
TX
Enumeration date
07/21/2006
Last updated
02/24/2021
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