Healthcare Provider Details

I. General information

NPI: 1083603757
Provider Name (Legal Business Name): CITY OF FORT STOCKTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W 2ND ST
FORT STOCKTON TX
79735-6711
US

IV. Provider business mailing address

121 W 2ND ST
FORT STOCKTON TX
79735-6711
US

V. Phone/Fax

Practice location:
  • Phone: 432-336-8525
  • Fax: 432-336-6273
Mailing address:
  • Phone: 432-336-8525
  • Fax: 432-336-6273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number186006
License Number StateTX

VIII. Authorized Official

Name: MRS. PENNY SMITH
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 432-336-8525