Healthcare Provider Details

I. General information

NPI: 1912229444
Provider Name (Legal Business Name): WYLIE FIRE-RESCUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801A SOUTH HWY. 78 204
WYLIE TX
75098
US

IV. Provider business mailing address

801A SOUTH HWY. 78 204
WYLIE TX
75098
US

V. Phone/Fax

Practice location:
  • Phone: 972-442-8110
  • Fax: 972-442-8113
Mailing address:
  • Phone: 972-442-8110
  • Fax: 972-442-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number300262
License Number StateTX

VIII. Authorized Official

Name: MR. ROBERT LYNN BALLARD
Title or Position: ADMINISTRATIVE CAPTAIN
Credential:
Phone: 972-442-8110