Healthcare Provider Details

I. General information

NPI: 1194821173
Provider Name (Legal Business Name): CITY OF SLATON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W LYNN ST
SLATON TX
79364-4134
US

IV. Provider business mailing address

PO BOX 694
SLATON TX
79364-0694
US

V. Phone/Fax

Practice location:
  • Phone: 806-828-2011
  • Fax:
Mailing address:
  • Phone: 806-828-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number152006
License Number StateTX

VIII. Authorized Official

Name: TYRA ROGERS
Title or Position: DIRECTOR
Credential: EMTP
Phone: 806-828-2011