1073671467 NPI number — NORTH TEXAS EMS

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 1073671467 NPI number — NORTH TEXAS EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS EMS
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:
1073671467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76124-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-535-6212
Provider Business Mailing Address Fax Number:
817-535-6233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7119 FOSTER STUART RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AZLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76020-5625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-535-6212
Provider Business Practice Location Address Fax Number:
817-535-6233
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FREED
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-535-6212

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  184002 , 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: P00218277 . This is a "RAILROAD MCARE PALMETTO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153312701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: AMB621 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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