Provider Demographics
NPI:1265447114
Name:CITY OF MEXIA
Entity Type:Organization
Organization Name:CITY OF MEXIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:254-562-4188
Mailing Address - Street 1:201 S MCKINNEY ST
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-3230
Mailing Address - Country:US
Mailing Address - Phone:254-562-4188
Mailing Address - Fax:254-472-0301
Practice Address - Street 1:201 S MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3230
Practice Address - Country:US
Practice Address - Phone:254-562-4188
Practice Address - Fax:254-472-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1470103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000103401Medicaid
TX000103401Medicaid
TX506280Medicare PIN