Provider Demographics
NPI:1487907143
Name:TRI CITY EMERGENCY MEDICAL SERVICE INC
Entity type:Organization
Organization Name:TRI CITY EMERGENCY MEDICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PARAMEDIC
Authorized Official - Phone:940-859-3488
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:TX
Mailing Address - Zip Code:76453-0271
Mailing Address - Country:US
Mailing Address - Phone:940-859-3488
Mailing Address - Fax:
Practice Address - Street 1:111 EAST CROCKETT ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:TX
Practice Address - Zip Code:76453
Practice Address - Country:US
Practice Address - Phone:940-859-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1820053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182005OtherEMS PROVIDER LICENSE