Provider Demographics
NPI:1598763708
Name:MITCHELL COUNTY AMBULANCE SERVICE
Entity type:Organization
Organization Name:MITCHELL COUNTY AMBULANCE SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-728-3431
Mailing Address - Street 1:997 W INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79512-2685
Mailing Address - Country:US
Mailing Address - Phone:325-728-3431
Mailing Address - Fax:325-728-8974
Practice Address - Street 1:997 W INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512-2685
Practice Address - Country:US
Practice Address - Phone:325-728-3431
Practice Address - Fax:325-728-8974
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MITCHELL COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-12
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X, 3416L0300X
TX168002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086489401Medicaid