Healthcare Provider Details

I. General information

NPI: 1588624241
Provider Name (Legal Business Name): CITY OF LULING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 S HACKBERRY
LULING TX
78648-1810
US

IV. Provider business mailing address

PO BOX 691363
HOUSTON TX
77269-1363
US

V. Phone/Fax

Practice location:
  • Phone: 830-875-9699
  • Fax: 830-875-9339
Mailing address:
  • Phone: 281-397-0397
  • Fax: 281-397-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN LAAKE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 281-397-0397