Provider Demographics
NPI:1629072129
Name:CITY OF IDALOU
Entity Type:Organization
Organization Name:CITY OF IDALOU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:MASCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:REG MA
Authorized Official - Phone:903-473-0927
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:IDALOU
Mailing Address - State:TX
Mailing Address - Zip Code:79329-1277
Mailing Address - Country:US
Mailing Address - Phone:903-473-0927
Mailing Address - Fax:832-877-5040
Practice Address - Street 1:208 MAIN ST
Practice Address - Street 2:
Practice Address - City:IDALOU
Practice Address - State:TX
Practice Address - Zip Code:79329
Practice Address - Country:US
Practice Address - Phone:903-473-0927
Practice Address - Fax:832-877-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00104241OtherMEDICARE RAIL ROAD
TX000015001Medicaid
TXP00104241OtherMEDICARE RAIL ROAD