Provider Demographics
NPI:1326180423
Name:CITY OF FRITCH
Entity Type:Organization
Organization Name:CITY OF FRITCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:806-857-2515
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:FRITCH
Mailing Address - State:TX
Mailing Address - Zip Code:79036
Mailing Address - Country:US
Mailing Address - Phone:806-857-2515
Mailing Address - Fax:806-857-5135
Practice Address - Street 1:104 N. ROBEY AVENUE
Practice Address - Street 2:
Practice Address - City:FRITCH
Practice Address - State:TX
Practice Address - Zip Code:79036
Practice Address - Country:US
Practice Address - Phone:806-857-2515
Practice Address - Fax:806-857-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1170023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086266601Medicaid
TX501803Medicare ID - Type UnspecifiedMEDICARE PART B