Healthcare Provider Details

I. General information

NPI: 1780710731
Provider Name (Legal Business Name): CITY OF CEDAR PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CYPRESS CREEK RD BUILDING 3
CEDAR PARK TX
78613-4194
US

IV. Provider business mailing address

PO BOX 691363
HOUSTON TX
77269-1363
US

V. Phone/Fax

Practice location:
  • Phone: 512-401-5220
  • Fax: 512-260-2464
Mailing address:
  • Phone: 281-397-0397
  • Fax: 281-397-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number246012
License Number StateTX

VIII. Authorized Official

Name: KAREN P LAAKE
Title or Position: ACCOUNT REPRESENTATIVE
Credential:
Phone: 281-397-0397