1245258037 NPI number — CITY OF SUNRAY

Table of content: (NPI 1245258037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245258037 NPI number — CITY OF SUNRAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SUNRAY
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:
1245258037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 180446
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75218-0446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-602-2060
Provider Business Mailing Address Fax Number:
903-887-1863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNRAY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-930-5791
Provider Business Practice Location Address Fax Number:
806-948-4485
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUMPAS
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
R
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
806-948-4111

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  171002 , 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: P00724454 . This is a "RAIL ROAD ID#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 102942100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000009301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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