Healthcare Provider Details

I. General information

NPI: 1245258037
Provider Name (Legal Business Name): CITY OF SUNRAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MAIN ST
SUNRAY TX
79086
US

IV. Provider business mailing address

PO BOX 180446
DALLAS TX
75218-0446
US

V. Phone/Fax

Practice location:
  • Phone: 806-930-5791
  • Fax: 806-948-4485
Mailing address:
  • Phone: 972-602-2060
  • Fax: 903-887-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number171002
License Number StateTX

VIII. Authorized Official

Name: KENNETH R BUMPAS JR.
Title or Position: EMS DIRECTOR
Credential: EMT-PARAMEDIC
Phone: 806-948-4111