Provider Demographics
NPI:1457499212
Name:CITY OF RICHARDSON
Entity Type:Organization
Organization Name:CITY OF RICHARDSON
Other - Org Name:CITY OF RICHARDSON EAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-744-4144
Mailing Address - Street 1:PO BOX 678629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8629
Mailing Address - Country:US
Mailing Address - Phone:855-978-6296
Mailing Address - Fax:888-972-9641
Practice Address - Street 1:411 W. ARAPAHO RD.
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:855-978-6296
Practice Address - Fax:888-972-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0570343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX590012733OtherRAILROAD MEDICARE
TX000031701Medicaid
TX504759OtherBLUE CROSS BLUE SHIELD
TX000031701Medicaid