Provider Demographics
NPI:1407994106
Name:CITY OF MARSHALL
Entity Type:Organization
Organization Name:CITY OF MARSHALL
Other - Org Name:MARSHALL/HARRISON COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-935-4585
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-0698
Mailing Address - Country:US
Mailing Address - Phone:214-340-2650
Mailing Address - Fax:214-503-7135
Practice Address - Street 1:601 S GROVE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5218
Practice Address - Country:US
Practice Address - Phone:214-340-2650
Practice Address - Fax:214-503-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086220301Medicaid
TX102001OtherDSHS
TX501188OtherBLUE CROSS BLUE SHIELD
TX590084030OtherRAILROAD MEDICARE