Provider Demographics
NPI:1225414832
Name:SOMERVELL COUNTY FIRE DEPARTMENT
Entity Type:Organization
Organization Name:SOMERVELL COUNTY FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-690-6163
Mailing Address - Street 1:111 SHEPARD STREET
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-4861
Mailing Address - Country:US
Mailing Address - Phone:254-897-2135
Mailing Address - Fax:254-897-4568
Practice Address - Street 1:111 SHEPARD STREET
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4861
Practice Address - Country:US
Practice Address - Phone:254-897-2135
Practice Address - Fax:254-897-4568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213004341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1912016106OtherNOVITAS SOLUTIONS
TX45D1027599OtherCENTERS FOR MEDICARE AND MEDICAID SERVICES (CLIA)