MEDICARE: CITY OF BRYAN

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	021006	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	:	1831155647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF BRYAN

Provider Business Mailing Address
First Line	:	P.O. BOX 1000
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77805-1000
Country	:	US
Telephone Number	:	979-209-5080
Fax Number	:	979-209-5095

Provider Business Practice Location Address
First Line	:	300 SOUTH TEXAS AVE
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77803-3226
Country	:	US
Telephone Number	:	979-209-5080
Fax Number	:	979-209-5095

Authorized Official
Title or Position	:	EMS CHIEF
Name	:	CORY MATTHEWS
Credential	:
Telephone Number	:	979-209-5970

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	11/02/2020

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Directions to “CITY OF BRYAN ” Practice Location

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