Healthcare Provider Details

I. General information

NPI: 1205841137
Provider Name (Legal Business Name): CITY OF COPPERAS COVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S MAIN ST
COPPERAS COVE TX
76522-2239
US

IV. Provider business mailing address

415 S MAIN ST
COPPERAS COVE TX
76522-2239
US

V. Phone/Fax

Practice location:
  • Phone: 254-547-2514
  • Fax: 254-547-3578
Mailing address:
  • Phone: 254-547-2514
  • Fax: 254-547-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number50003
License Number StateTX

VIII. Authorized Official

Name: GARY YOUNG
Title or Position: EMS ADMINISTRATOR
Credential:
Phone: 254-547-2514