Provider Demographics
NPI:1295830388
Name:CITY OF GRAPELAND
Entity Type:Organization
Organization Name:CITY OF GRAPELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS ASSISTANTT CHIEF
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHASTITY
Authorized Official - Middle Name:LORI ANN
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:936-687-2115
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:GRAPELAND
Mailing Address - State:TX
Mailing Address - Zip Code:75844-0567
Mailing Address - Country:US
Mailing Address - Phone:936-687-2115
Mailing Address - Fax:936-687-2799
Practice Address - Street 1:126 SOUTH OAK
Practice Address - Street 2:
Practice Address - City:GRAPELAND
Practice Address - State:TX
Practice Address - Zip Code:75844
Practice Address - Country:US
Practice Address - Phone:936-687-2115
Practice Address - Fax:936-687-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0863888-01Medicaid
TX503374Medicare PIN