Provider Demographics
NPI:1184653925
Name:CITY OF CLEBURNE
Entity Type:Organization
Organization Name:CITY OF CLEBURNE
Other - Org Name:CLEBURNE FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:ISHMAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-645-0965
Mailing Address - Street 1:114 W. WARDVILLE
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4918
Mailing Address - Country:US
Mailing Address - Phone:817-645-0964
Mailing Address - Fax:817-645-0967
Practice Address - Street 1:114 W. WARDVILLE
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4918
Practice Address - Country:US
Practice Address - Phone:817-645-0964
Practice Address - Fax:817-645-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
TX3006433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162773901Medicaid
TXAMB337Medicare PIN