Organization
COUNTY OF SOMERVELL
Active
Other names
Somervell County EMS
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER MARION MAYNARD (COUNTY JUDGE)
(254) 897-2322
Entity
Organization
Contact information
Practice address
111 SHEPPARD STREET, GLEN ROSE, TX 76043
(254) 897-2135
(254) 897-4568
Mailing address
PO BOX 279, 111 SHEPPARD STREET, GLEN ROSE, TX 76043
(254) 897-2135
(254) 897-4568
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
213004
TX
146M00000X
Intermediate Emergency Medical Technician
213004
TX
146N00000X
Basic Emergency Medical Technician
213004
TX
3416L0300X
Land Ambulance
Primary
213004
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213004
TX DSHS EMS LICENSE#
TX
01
—
AMB792
BLUE CROSS BLUE SHIELD OF TEXAS
TX
01
—
P00280460
RAILROAD MEDICARE
TX
Enumeration date
08/30/2006
Last updated
03/28/2014
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