Provider Demographics
NPI:1558485300
Name:CITY OF GROOM
Entity Type:Organization
Organization Name:CITY OF GROOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-248-7003
Mailing Address - Street 1:8300 BISSONNET ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3900
Mailing Address - Country:US
Mailing Address - Phone:713-773-4355
Mailing Address - Fax:713-773-4363
Practice Address - Street 1:203 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GROOM
Practice Address - State:TX
Practice Address - Zip Code:79039
Practice Address - Country:US
Practice Address - Phone:806-248-7003
Practice Address - Fax:806-820-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX033001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189120201Medicaid