MEDICARE: CITY OF GRAND SALINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	234017	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639120629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF GRAND SALINE

Provider Business Mailing Address
First Line	:	PO BOX 217
Second Line	:	115 N. GREEN
City	:	GRAND SALINE
State	:	TX
Zip	:	75140-0217
Country	:	US
Telephone Number	:	903-962-3727
Fax Number	:	903-962-5597

Provider Business Practice Location Address
First Line	:	115 N GREEN ST
Second Line	:
City	:	GRAND SALINE
State	:	TX
Zip	:	75140-1861
Country	:	US
Telephone Number	:	903-962-3727
Fax Number	:	903-962-5597

Authorized Official
Title or Position	:	EMS SUPERVISER
Name	:	MR. STEPHEN GRAY
Credential	:
Telephone Number	:	903-962-3727

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	07/25/2008

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Directions to “CITY OF GRAND SALINE ” Practice Location

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