Provider Demographics
NPI:1043213606
Name:CITY OF SCHERTZ
Entity Type:Organization
Organization Name:CITY OF SCHERTZ
Other - Org Name:CITY OF SCHERTZ EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF EMS
Authorized Official - Prefix:MR
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WAIT
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:210-619-1400
Mailing Address - Street 1:1400 SCHERTZ PKWY
Mailing Address - Street 2:BLDG 7
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1673
Mailing Address - Country:US
Mailing Address - Phone:210-619-1400
Mailing Address - Fax:210-619-1499
Practice Address - Street 1:1400 SCHERTZ PKWY
Practice Address - Street 2:BLDG 7
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1673
Practice Address - Country:US
Practice Address - Phone:210-619-1400
Practice Address - Fax:210-619-1450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF SCHERTZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-27
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0940043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086556001Medicaid
TX504564Medicare PIN
TX086556001Medicaid