=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851597538
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF KIRBY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2007
-----------------------------------------------------
Last Update Date | 12/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5560 DUFFEK
-----------------------------------------------------
City | KIRBY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-661-2612
-----------------------------------------------------
Fax | 210-661-8074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 BAUMAN ST
-----------------------------------------------------
City | KIRBY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78219-1004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-661-2612
-----------------------------------------------------
Fax | 210-661-8074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS ADMINISTRATOR
-----------------------------------------------------
Name | MR. LAIRD D BRETZ
-----------------------------------------------------
Credential | EMS-CAPTAIN
-----------------------------------------------------
Telephone | 210-661-2612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 015026
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------