MEDICARE: CITY OF LUCAS

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	3416L0300X	Land Ambulance	1000929	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000929	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1477963239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF LUCAS

Provider Business Mailing Address
First Line	:	PO BOX 180446
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-0446
Country	:	US
Telephone Number	:	877-602-2060
Fax Number	:	800-608-9457

Provider Business Practice Location Address
First Line	:	165 COUNTRY CLUB RD
Second Line	:
City	:	LUCAS
State	:	TX
Zip	:	75002-7663
Country	:	US
Telephone Number	:	972-727-1242
Fax Number	:	800-608-9457

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	TED STEPHENS
Credential	:
Telephone Number	:	972-727-1242

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	04/25/2024

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Directions to “CITY OF LUCAS ” Practice Location

Language	Start Address	Practice Location

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