Provider Demographics
NPI:1083603757
Name:CITY OF FORT STOCKTON
Entity Type:Organization
Organization Name:CITY OF FORT STOCKTON
Other - Org Name:FORT STOCKTON AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-336-8525
Mailing Address - Street 1:121 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-6711
Mailing Address - Country:US
Mailing Address - Phone:432-336-8525
Mailing Address - Fax:432-336-6273
Practice Address - Street 1:121 W 2ND ST
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-6711
Practice Address - Country:US
Practice Address - Phone:432-336-8525
Practice Address - Fax:432-336-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186006341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB233Medicare ID - Type Unspecified