=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598781742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF MANSFIELD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 01/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1305 E BROAD ST
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-276-4790
-----------------------------------------------------
Fax | 817-276-4787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 E BROAD ST
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-276-4790
-----------------------------------------------------
Fax | 817-276-4787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS CHIEF
-----------------------------------------------------
Name | KEVIN SANDIFER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-804-5772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 220014
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------