Organization
HARDIN COUNTY EMERGENCY SERVICE DISTRICT NO 5
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN WITHERS (BOARD PRESIDENT)
(409) 287-3062
Entity
Organization
Contact information
Practice address
711 6TH ST, SOUR LAKE, TX 77659
(409) 287-3062
(409) 287-3406
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
—
1635634
—
LA
05
—
177491101
—
TX
01
—
590015398
RAILROAD MEDICARE
—
Enumeration date
03/10/2006
Last updated
12/05/2011
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