1811041023 NPI number — CITY OF DEER PARK

Table of content: (NPI 1811041023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811041023 NPI number — CITY OF DEER PARK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF DEER PARK
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:
1811041023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEER PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77536-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-478-7281
Provider Business Mailing Address Fax Number:
281-478-7289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 EAST X STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEER PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77536-4293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-478-7281
Provider Business Practice Location Address Fax Number:
281-478-7289
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLETCHER
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
AMBULANCE BILLING CLERK
Authorized Official Telephone Number:
281-478-7281

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  101022 , 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: 0000911-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 505970 . This is a "911 EMERGENCY AMBULANCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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