Provider Demographics
NPI:1467473165
Name:CITY OF ADDISON
Entity Type:Organization
Organization Name:CITY OF ADDISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-450-7091
Mailing Address - Street 1:PO BOX 180819
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218
Mailing Address - Country:US
Mailing Address - Phone:972-450-7090
Mailing Address - Fax:972-450-7096
Practice Address - Street 1:4798 AIRPORT PKWY
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3364
Practice Address - Country:US
Practice Address - Phone:972-450-7201
Practice Address - Fax:972-450-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5041813416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000021801Medicaid
TXAMB833OtherBLUE CROSS BLUE SHIELD
TX590007397OtherRAILROAD MEDICARE
TXAMB833OtherBLUE CROSS BLUE SHIELD