Healthcare Provider Details

I. General information

NPI: 1770566077
Provider Name (Legal Business Name): CITY OF STINNETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 MAIN STREET
STINNETT TX
79083-0909
US

IV. Provider business mailing address

PO BOX 909
STINNETT TX
79083-0909
US

V. Phone/Fax

Practice location:
  • Phone: 806-878-3766
  • Fax: 806-878-2084
Mailing address:
  • Phone: 806-878-2422
  • Fax: 806-878-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number117003
License Number StateTX

VIII. Authorized Official

Name: JEFFREY WAYNE STIEG
Title or Position: DIRECTOR
Credential: PARAMEDIC, AOR
Phone: 806-201-2705