1003830662 NPI number — CITY OF KRUM

Table of content: (NPI 1003830662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003830662 NPI number — CITY OF KRUM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF KRUM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KRUM FIRE DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003830662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 333
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KRUM
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76249-0333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-482-6257
Provider Business Mailing Address Fax Number:
940-482-3705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 W. LAKE ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KRUM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-482-6257
Provider Business Practice Location Address Fax Number:
940-482-3705
Provider Enumeration Date:
07/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOONE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
BRANDON
Authorized Official Title or Position:
ASSISTANT FIRE CHIEF
Authorized Official Telephone Number:
940-482-6257

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  61267 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 184810301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: AMB738 . This is a "BC BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".