Provider Demographics
NPI:1205841137
Name:CITY OF COPPERAS COVE
Entity Type:Organization
Organization Name:CITY OF COPPERAS COVE
Other - Org Name:CITY OF COPPERAS COVE FIRE DEPT/EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-547-2514
Mailing Address - Street 1:415 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2239
Mailing Address - Country:US
Mailing Address - Phone:254-547-2514
Mailing Address - Fax:254-547-3578
Practice Address - Street 1:415 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2239
Practice Address - Country:US
Practice Address - Phone:254-547-2514
Practice Address - Fax:254-547-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX500033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000174501Medicaid
TX507429OtherBS/BS OF TEXAS
TX590000140Medicare PIN
TX507429Medicare PIN