Provider Demographics
NPI:1710064100
Name:CITY OF HUMBLE
Entity Type:Organization
Organization Name:CITY OF HUMBLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:WYATT
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-446-2212
Mailing Address - Street 1:114 W HIGGINS ST
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4305
Mailing Address - Country:US
Mailing Address - Phone:281-446-7889
Mailing Address - Fax:281-446-7491
Practice Address - Street 1:114 W HIGGINS ST
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4305
Practice Address - Country:US
Practice Address - Phone:281-446-7889
Practice Address - Fax:281-446-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
TX1010873416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10020671OtherAMERIGROUP
TX000183601Medicaid
TX507597OtherBLUE CROSS BLUE SHIELD
TX59001484Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX10020671OtherAMERIGROUP