1780637512 NPI number — CITY OF ENNIS

Table of content: (NPI 1780637512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780637512 NPI number — CITY OF ENNIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF ENNIS
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:
6
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:
1780637512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/25/2006
NPI Reactivation Date:
11/15/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 MARGARET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDALE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75771-3215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-882-7561
Provider Business Mailing Address Fax Number:
903-882-9797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 MARGARET ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDALE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-882-7561
Provider Business Practice Location Address Fax Number:
903-882-9797
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
MARTY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CITY MANAGER
Authorized Official Telephone Number:
972-875-1234

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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: 004319 . This is a "FACILITY ID NO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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