1043395304 NPI number — CITY OF KINGSVILLE

Table of content: (NPI 1043395304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043395304 NPI number — CITY OF KINGSVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF KINGSVILLE
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:
Provider Other Organization Name Type Code:
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:
1043395304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1458
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78364-1458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-595-8009
Provider Business Mailing Address Fax Number:
361-595-8035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 N 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78363-4622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-592-6445
Provider Business Practice Location Address Fax Number:
361-595-4798
Provider Enumeration Date:
10/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUSHING
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
361-595-8009

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  137001 , 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: 10011752 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 590482041 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086178301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".