Provider Demographics
NPI:1003849795
Name:CITY OF WOLFFORTH
Entity Type:Organization
Organization Name:CITY OF WOLFFORTH
Other - Org Name:CITY OF WOLFFORTH EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-866-4215
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-0036
Mailing Address - Country:US
Mailing Address - Phone:806-866-4215
Mailing Address - Fax:
Practice Address - Street 1:305 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:WOLFFORTH
Practice Address - State:TX
Practice Address - Zip Code:79382
Practice Address - Country:US
Practice Address - Phone:806-866-9126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152011146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000037401Medicaid
TX504967Medicare ID - Type UnspecifiedPROVIDER NUMBER