Provider Demographics
NPI:1558384552
Name:CITY OF KELLER
Entity Type:Organization
Organization Name:CITY OF KELLER
Other - Org Name:KELLER FIRE - RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-743-4451
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-0770
Mailing Address - Country:US
Mailing Address - Phone:817-743-4400
Mailing Address - Fax:817-743-4409
Practice Address - Street 1:1100 BEAR CREEK PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2114
Practice Address - Country:US
Practice Address - Phone:817-743-4400
Practice Address - Fax:817-743-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2200323416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX506898OtherBC/BS OF TEXAS
TX000143001Medicaid
TX590011220Medicare PIN
TX000143001Medicaid