MEDICARE: CITY OF MANSFIELD

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	220014	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598781742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF MANSFIELD

Provider Business Mailing Address
First Line	:	1305 E BROAD ST
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1804
Country	:	US
Telephone Number	:	817-276-4790
Fax Number	:	817-276-4787

Provider Business Practice Location Address
First Line	:	1305 E BROAD ST
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1804
Country	:	US
Telephone Number	:	817-276-4790
Fax Number	:	817-276-4787

Authorized Official
Title or Position	:	EMS CHIEF
Name	:	KEVIN SANDIFER
Credential	:
Telephone Number	:	817-804-5772

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/27/2021

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Directions to “CITY OF MANSFIELD ” Practice Location

Language	Start Address	Practice Location

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