Provider Demographics
NPI:1447454673
Name:BRAZORIA COUNTY EMS INC
Entity type:Organization
Organization Name:BRAZORIA COUNTY EMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-222-1335
Mailing Address - Street 1:PO BOX 3242
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77542-1442
Mailing Address - Country:US
Mailing Address - Phone:888-222-1335
Mailing Address - Fax:979-266-9211
Practice Address - Street 1:223 N GULF BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-4305
Practice Address - Country:US
Practice Address - Phone:888-222-1335
Practice Address - Fax:979-266-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10000323416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185940701Medicaid
TXAMB874OtherBC/BS OF TEXAS PROVIDER #
TX185940701Medicaid
TXAMB874OtherBC/BS OF TEXAS PROVIDER #