Provider Demographics
NPI:1104286087
Name:ETMC EMS
Entity type:Organization
Organization Name:ETMC EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-535-5809
Mailing Address - Street 1:352 S GLENWOOD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-6936
Mailing Address - Country:US
Mailing Address - Phone:903-535-5800
Mailing Address - Fax:903-590-5810
Practice Address - Street 1:352 S GLENWOOD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-6936
Practice Address - Country:US
Practice Address - Phone:903-535-5800
Practice Address - Fax:903-590-5810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST TEXAS MEDICAL CENTER REGION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2120023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport