Healthcare Provider Details

I. General information

NPI: 1689742108
Provider Name (Legal Business Name): CITY OF SHALLOWATER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 AVENUE G
SHALLOWATER TX
79363-5709
US

IV. Provider business mailing address

PO BOX 246
SHALLOWATER TX
79363-0246
US

V. Phone/Fax

Practice location:
  • Phone: 806-832-4521
  • Fax: 806-832-4495
Mailing address:
  • Phone: 806-832-0609
  • Fax: 806-832-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number152012
License Number StateTX

VIII. Authorized Official

Name: MS. AMANDA CUMMINGS
Title or Position: EMS BILLING
Credential:
Phone: 806-832-4521