Provider Demographics
NPI:1083632996
Name:CITY OF CORSICANA
Entity Type:Organization
Organization Name:CITY OF CORSICANA
Other - Org Name:CORSICANA FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-654-4960
Mailing Address - Street 1:PO BOX 222059
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-2059
Mailing Address - Country:US
Mailing Address - Phone:877-602-2060
Mailing Address - Fax:
Practice Address - Street 1:2975 DRANE RD
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-0001
Practice Address - Country:US
Practice Address - Phone:903-654-4956
Practice Address - Fax:903-874-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
TX3005323416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX590015432OtherRAILROAD MEDICARE
TX1083632996Medicaid
TXAMB639OtherBLUE CROSS BLUE SHIELD
TX590015432OtherRAILROAD MEDICARE
TXAMB255Medicare UPIN
TX155787801Medicaid