| Organization Name: | POWELL PROFESSIONAL OF WEST TEXAS, LLC |
| NPI Number: | 1104137322 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICKY LEE POWELL (MEMBER) |
| Mailing Address: | 1501 4th St Brownwood |
| State: | TX US |
| Postal Code: | 768014430 |
| Phone Number: | 3256434840 |
| Fax Number: | |
| NPI Enumeration Date: | 06/23/2010 |
| NPI Last Update Date: | 07/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | 100469 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |