MEDICARE: CITY OF CEDAR PARK FIRE DEPARTMENT

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	146N00000X	Basic Emergency Medical Technician	246012	TX

General Provider Information

NPI Number	:	1578963344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CEDAR PARK FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	450 CYPRESS CREEK RD
Second Line	:	BUILDING 3
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-4194
Country	:	US
Telephone Number	:	512-401-5000
Fax Number	:	512-260-2464

Provider Business Practice Location Address
First Line	:	450 CYPRESS CREEK RD
Second Line	:	BUILDING 3
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-4194
Country	:	US
Telephone Number	:	512-401-5000
Fax Number	:	512-260-2464

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	JAMES MALLINGER
Credential	:
Telephone Number	:	512-401-5220

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	08/29/2014

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