Provider Demographics
NPI:1639120629
Name:CITY OF GRAND SALINE
Entity Type:Organization
Organization Name:CITY OF GRAND SALINE
Other - Org Name:GRAND SALINE FIRE DEPT. EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS SUPERVISER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-962-3727
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:115 N. GREEN
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-0217
Mailing Address - Country:US
Mailing Address - Phone:903-962-3727
Mailing Address - Fax:903-962-5597
Practice Address - Street 1:115 N GREEN ST
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1861
Practice Address - Country:US
Practice Address - Phone:903-962-3727
Practice Address - Fax:903-962-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2340173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA05073050Medicaid
TXA05073050Medicaid