FAYETTE COUNTY — NPI 1215958863 (Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance in LA GRANGE, TX)

CMS-1500 Box 24J / 33a • NPI

1215958863

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

3416L0300X (CMS 59)

Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance

Box 32 Service Location & ZIP+4

1721 VON MINDEN RD, LA GRANGE, TX, 78945-2400

✓ 9-Digit EDI 837 ZIP+4 (78945-2400)

Practice Phone & Referral Fax

(979) 968-8991

Fax: (979) 968-9488

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1215958863 (FAYETTE COUNTY) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1215958863` (NPI-2 Organization / Facility)
Provider / Legal Name	FAYETTE COUNTY
Plain-English Specialty	Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance NUCC Code: `3416L0300X` (Ambulance, Land Transport)
Certifying / Licensing Body	State EMS Authority / National Registry of Emergency Medical Technicians (NREMT)
Practice Location Address	1721 VON MINDEN RD, LA GRANGE, TX, 78945-2400
Practice Telephone / Fax	Tel: (979) 968-8991 \| Fax: (979) 968-9488
Administrative Mailing Address	PO BOX 181389, DALLAS, TX, 75218-8389
Enumeration & Last Sync	Enumerated: 2006-07-21 \| CMS Record Updated: 2026-09-21
Authorized Official	JOSHUA VANDEVER (EMS Director)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1721 VON MINDEN RD, LA GRANGE, TX, 78945-2400

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Plain-English Taxonomy & CMS Crosswalk (3416L0300X)

What Does Taxonomy Code 3416L0300X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3416L0300X translates to:
"Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 59 (Ambulance Service Provider)
Certifying / Accrediting Authority: State EMS Authority / National Registry of Emergency Medical Technicians (NREMT)
Clinical Scope: Emergency 911 pre-hospital medical response or medically supervised inter-hospital critical care transport.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (FAYETTE COUNTY)

Typical CPT / Diagnostic Procedures:

Advanced Life Support (ALS) Pre-Hospital Cardiac Monitoring & Defibrillation
Pre-Hospital Trauma Immobilization, Airway Management & IV Access

Common Therapeutic Classes:

Pre-Hospital Epinephrine, Aspirin, Nitroglycerin, Naloxone & Albuterol

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`341600000X` — Ambulance Plain English: Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance	State: TX \| License: `75001` \| Primary: Secondary
`3416L0300X` — Ambulance, Land Transport Plain English: Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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FAYETTE COUNTY (NPI #1215958863)