Provider Demographics
NPI:1689742108
Name:CITY OF SHALLOWATER
Entity Type:Organization
Organization Name:CITY OF SHALLOWATER
Other - Org Name:CITY OF SHALLOWATER EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-832-4521
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-0246
Mailing Address - Country:US
Mailing Address - Phone:806-832-0609
Mailing Address - Fax:806-832-5373
Practice Address - Street 1:607 AVENUE G
Practice Address - Street 2:
Practice Address - City:SHALLOWATER
Practice Address - State:TX
Practice Address - Zip Code:79363-5709
Practice Address - Country:US
Practice Address - Phone:806-832-4521
Practice Address - Fax:806-832-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1520123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0866196-01Medicaid
TX105942100OtherFIRSTCARE
TX105942100OtherFIRSTCARE