Healthcare Provider Details

I. General information

NPI: 1790790947
Provider Name (Legal Business Name): CITY OF GRAPEVINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BOYD DR
GRAPEVINE TX
76051-6245
US

IV. Provider business mailing address

PO BOX 95104
GRAPEVINE TX
76099-9704
US

V. Phone/Fax

Practice location:
  • Phone: 817-410-8100
  • Fax: 817-410-8106
Mailing address:
  • Phone: 877-659-0519
  • Fax: 914-741-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number220025
License Number StateTX

VIII. Authorized Official

Name: STEVE BASS
Title or Position: FIRE CHIEF
Credential:
Phone: 817-410-8100