Provider Demographics
NPI:1265498935
Name:CITY OF SAN ANGELO
Entity Type:Organization
Organization Name:CITY OF SAN ANGELO
Other - Org Name:MUNICIPAL AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-657-4356
Mailing Address - Street 1:PO BOX 2289
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-2289
Mailing Address - Country:US
Mailing Address - Phone:800-460-1444
Mailing Address - Fax:210-224-6945
Practice Address - Street 1:306 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5707
Practice Address - Country:US
Practice Address - Phone:325-657-4356
Practice Address - Fax:325-658-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2260073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088202901Medicaid
TX826590501Medicare PIN
TX506653Medicare PIN