Provider Demographics
NPI:1114355625
Name:COUNTY OF COTTLE
Entity type:Organization
Organization Name:COUNTY OF COTTLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TANA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DETWILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-492-2336
Mailing Address - Street 1:808 10TH STREET
Mailing Address - Street 2:PO BOX 502
Mailing Address - City:PADUCAH
Mailing Address - State:TX
Mailing Address - Zip Code:79248-0502
Mailing Address - Country:US
Mailing Address - Phone:806-492-2336
Mailing Address - Fax:806-492-2049
Practice Address - Street 1:808 10TH STREET
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:TX
Practice Address - Zip Code:79248-0502
Practice Address - Country:US
Practice Address - Phone:806-492-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX051002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX504852Medicare PIN