Provider Demographics
NPI:1508887258
Name:CITY OF NASSAU BAY
Entity Type:Organization
Organization Name:CITY OF NASSAU BAY
Other - Org Name:CITY OF NASSAU BAY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CSILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-336-6284
Mailing Address - Street 1:1800 SPACE PARK DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058
Mailing Address - Country:US
Mailing Address - Phone:281-335-5380
Mailing Address - Fax:281-333-2301
Practice Address - Street 1:18100 UPPER BAY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3548
Practice Address - Country:US
Practice Address - Phone:281-335-5380
Practice Address - Fax:281-333-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010463416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101046OtherDSHS LICENSE
TX590012635OtherRAILROAD MEDICARE PIN
TX000640501Medicaid
TX528275OtherBC/BS OF TEXAS
TX528275OtherBC/BS OF TEXAS