Organization
LIBERTY COUNTY EMERGENCY MEDICAL SERVICES INC
Active
Other names
HULL DAISETTA VOL. AMBULANCE SERVICE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM MICHAEL KOEN (EXECUTIVE DIRECTOR)
(936) 536-3080
Entity
Organization
Contact information
Practice address
114 MAIN ST., DAISETTA, TX 77533
(936) 536-3080
(936) 536-6519
Mailing address
PO BOX 351, HULL, TX 77564-0351
(936) 536-3080
(936) 536-6519
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
146013
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000519101
—
TX
05
—
1161942
—
LA
01
—
517216
BCBS
TX
Enumeration date
09/05/2006
Last updated
05/24/2010
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