Provider Demographics
NPI:1255498952
Name:CITY OF DEVINE AMBULANCE SERVICE
Entity Type:Organization
Organization Name:CITY OF DEVINE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LIC-P
Authorized Official - Phone:830-663-2121
Mailing Address - Street 1:303 S TEEL DR
Mailing Address - Street 2:
Mailing Address - City:DEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:78016-3211
Mailing Address - Country:US
Mailing Address - Phone:830-663-2121
Mailing Address - Fax:
Practice Address - Street 1:303 S TEEL DR
Practice Address - Street 2:
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-3211
Practice Address - Country:US
Practice Address - Phone:830-663-2121
Practice Address - Fax:830-663-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163004341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX504280OtherBCFED
TX504280OtherBCBS
TX504280Medicare PIN