MEDICARE: CITY OF GRAND PRAIRIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	300276	TX
2	3416L0300X	Land Ambulance

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590014260	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AMB559	OTHER	TX	COMMERCIAL INSURANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194728402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF GRAND PRAIRIE

Provider Business Mailing Address
First Line	:	1525 ARKANSAS LN
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7401
Country	:	US
Telephone Number	:	972-237-8300
Fax Number	:	972-237-8309

Provider Business Practice Location Address
First Line	:	1525 ARKANSAS LN
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7401
Country	:	US
Telephone Number	:	972-237-8300
Fax Number	:	972-237-8309

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	ERIKA V SOTO
Credential	:
Telephone Number	:	972-237-8388

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/28/2024

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Directions to “CITY OF GRAND PRAIRIE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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