Healthcare Provider Details

I. General information

NPI: 1578963344
Provider Name (Legal Business Name): CITY OF CEDAR PARK FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/29/2014
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

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

V. Phone/Fax

Practice location:
  • Phone: 512-401-5000
  • Fax: 512-260-2464
Mailing address:
  • Phone: 512-401-5000
  • Fax: 512-260-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number246012
License Number StateTX

VIII. Authorized Official

Name: JAMES MALLINGER
Title or Position: FIRE CHIEF
Credential:
Phone: 512-401-5220