Hardin County Emergency Service District No 5

Primary specialty

AmbulanceTaxonomy code 341600000X

Legal business name

HARDIN COUNTY EMERGENCY SERVICE DISTRICT NO 5

Practice address

711 6TH St
Sour Lake, TX 77659

Phone

(409) 287-3062

Fax

(409) 287-3406

NPI assigned

Mar 10, 2006

Last updated

Dec 5, 2011By 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

Glen Withers

Title

Board President

Phone

(409) 287-3062

Specialties & licenses 1

Addresses

Other identifiers 3

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": "1141948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323043200000",
    "number": "1316915879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 691363",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772691363",
            "telephone_number": "281-397-0397",
            "fax_number": "281-397-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 6TH ST",
            "city": "SOUR LAKE",
            "state": "TX",
            "postal_code": "77659",
            "telephone_number": "409-287-3062",
            "fax_number": "409-287-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARDIN COUNTY EMERGENCY SERVICE DISTRICT NO 5",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-10",
        "last_updated": "2011-12-05",
        "status": "A",
        "authorized_official_last_name": "WITHERS",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "BOARD PRESIDENT",
        "authorized_official_telephone_number": "409-287-3062"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177491101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590015398",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1635634",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darlene Bryan
• Ginger Lee Coburn, FNP
• Amy Renee Dale, FNP-C
• Angela Ford
• Lacey Ann Guedry, FNP-C
• Patricia Ann Heirtzler, FNP-C
• Karla Michelle Kicak, M.S., CCC-SLP
• Shawn D Klinger, A.T.C, L.A.T
• Lauren Letsinger
• Kristine Matlock

• Ambulance in Sour Lake, TX
• Providers in Sour Lake, TX by specialty
• Ambulance in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; 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.