MEDICARE: CITY OF MATHIS

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	205011	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590007414	OTHER	TX	RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356456586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF MATHIS

Provider Business Mailing Address
First Line	:	PO BOX 290184
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06129-0184
Country	:	US
Telephone Number	:	860-257-7080
Fax Number	:	860-563-3403

Provider Business Practice Location Address
First Line	:	411 E SAN PATRICIO AVE
Second Line	:
City	:	MATHIS
State	:	TX
Zip	:	78368-2351
Country	:	US
Telephone Number	:	361-547-3995
Fax Number	:	361-547-4214

Authorized Official
Title or Position	:	AUTHORIZED AGENT
Name	:	MRS. MARY T GENTILE
Credential	:
Telephone Number	:	860-257-7080

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	09/17/2013

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Directions to “CITY OF MATHIS ” Practice Location

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