Healthcare Provider Details

I. General information

NPI: 1831138775
Provider Name (Legal Business Name): CITY OF TEXAS CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 25TH STREET N
TEXAS CITY TX
77590
US

IV. Provider business mailing address

1725 25TH STREET N
TEXAS CITY TX
77590
US

V. Phone/Fax

Practice location:
  • Phone: 409-643-5705
  • Fax: 409-643-5719
Mailing address:
  • Phone: 409-643-5705
  • Fax: 409-643-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number300076
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. WENDELL E WILEY II
Title or Position: EMS ADMINISTRATOR
Credential: CAPTAIN
Phone: 409-643-5705