Provider Demographics
NPI:1619998564
Name:THE EAGLE MOUNTAIN VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:THE EAGLE MOUNTAIN VOLUNTEER FIRE DEPARTMENT
Other - Org Name:EAGLE MOUNTAIN FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-236-8044
Mailing Address - Street 1:9500 LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-4061
Mailing Address - Country:US
Mailing Address - Phone:817-236-8044
Mailing Address - Fax:817-236-3923
Practice Address - Street 1:9500 LIVE OAK LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-4061
Practice Address - Country:US
Practice Address - Phone:866-398-8999
Practice Address - Fax:866-724-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2200333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX507572OtherBC/BS OF TEXAS
TX000178601Medicaid
TX590005582Medicare PIN
TX507572OtherBC/BS OF TEXAS