1689742108 NPI number — CITY OF SHALLOWATER

Table of content: (NPI 1689742108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689742108 NPI number — CITY OF SHALLOWATER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SHALLOWATER
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:
CITY OF SHALLOWATER EMS
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:
1689742108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHALLOWATER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79363-0246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-832-0609
Provider Business Mailing Address Fax Number:
806-832-5373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 AVENUE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHALLOWATER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79363-5709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-832-4521
Provider Business Practice Location Address Fax Number:
806-832-4495
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINGS
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS BILLING
Authorized Official Telephone Number:
806-832-4521

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  152012 , 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: 0866196-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105942100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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