MEDICARE: CITY OF GLENN HEIGHTS

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	57007	TX

General Provider Information

NPI Number	:	1922045392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF GLENN HEIGHTS

Provider Business Mailing Address
First Line	:	1938 S HAMPTON RD
Second Line	:
City	:	GLENN HEIGHTS
State	:	TX
Zip	:	75154-8534
Country	:	US
Telephone Number	:	972-223-1690
Fax Number	:	972-274-4507

Provider Business Practice Location Address
First Line	:	1938 S HAMPTON RD
Second Line	:
City	:	GLENN HEIGHTS
State	:	TX
Zip	:	75154-8534
Country	:	US
Telephone Number	:	972-223-1690
Fax Number	:	972-274-4507

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	CHRISTOPHER D SHOOK
Credential	:
Telephone Number	:	972-223-1690

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	12/17/2007

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