County of Jeff Davis

Primary specialty

AmbulanceTaxonomy code 341600000X

License

122002 Issued in TX

Legal business name

COUNTY OF JEFF DAVIS

Practice address

201 W Court Ave
Fort Davis, TX 79734

Phone

(432) 426-3791

NPI assigned

Aug 8, 2007

Last updated

Apr 19, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Vickie L Fowler

Title

EMS Director

Phone

(432) 426-3791

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jeff Davis County Other name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334793600000",
    "number": "1023209582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W COURT AVE",
            "city": "FORT DAVIS",
            "state": "TX",
            "postal_code": "79734",
            "telephone_number": "432-426-3791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W COURT AVE",
            "city": "FORT DAVIS",
            "state": "TX",
            "postal_code": "79734",
            "telephone_number": "432-426-3791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF JEFF DAVIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-08",
        "last_updated": "2012-04-19",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EMS DIRECTOR",
        "authorized_official_telephone_number": "432-426-3791",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "TX",
            "license": "122002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0004525-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeff Davis County",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Fort Davis Family Practice, PA
• Fort Davis Independent School District
• Thomas John Homrighaus, LPC
• James Luecke, MD
• Silvanna Lynn Ramos Milan, LMSW

• Ambulance in Fort Davis, TX
• Providers in Fort Davis, TX by specialty
• Ambulance in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.