1215930672 NPI number — CITY OF BENBROOK

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215930672 NPI number — CITY OF BENBROOK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BENBROOK
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:
1215930672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26569
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENBROOK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76126-0569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-249-3000
Provider Business Mailing Address Fax Number:
817-249-0884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
528 MERCEDES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENBROOK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76126-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-249-1727
Provider Business Practice Location Address Fax Number:
817-249-0884
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
TOMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
817-249-1727

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  220022 , 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: 086550301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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