=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811041023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF DEER PARK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 02/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2211 EAST X STREET
-----------------------------------------------------
City | DEER PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77536-4293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-478-7281
-----------------------------------------------------
Fax | 281-478-7289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 700
-----------------------------------------------------
City | DEER PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77536-0700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-478-7281
-----------------------------------------------------
Fax | 281-478-7289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBULANCE BILLING CLERK
-----------------------------------------------------
Name | MRS. JENNIFER FLETCHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-478-7281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 101022
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------