=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114273661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DALLAS FIRE RESCUE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2012
-----------------------------------------------------
Last Update Date | 08/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 DOLPHIN RD BLDG. A
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75223-3112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-670-3220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5000 DOLPHIN RD BLDG. A
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75223-3112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-670-3220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMMUNICABLE DISEASE COORDINATOR
-----------------------------------------------------
Name | MS. MYRTLE ALLISON GREEN
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 469-323-5775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number | 256388
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------