Provider Demographics
NPI:1760589493
Name:CITY OF CLUTE
Entity Type:Organization
Organization Name:CITY OF CLUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WAGUESPACK
Authorized Official - Suffix:
Authorized Official - Credentials:EMT PARAMEDIC
Authorized Official - Phone:979-265-9653
Mailing Address - Street 1:231 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:CLUTE
Mailing Address - State:TX
Mailing Address - Zip Code:77531-5603
Mailing Address - Country:US
Mailing Address - Phone:979-265-9653
Mailing Address - Fax:979-265-2947
Practice Address - Street 1:231 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:CLUTE
Practice Address - State:TX
Practice Address - Zip Code:77531-5603
Practice Address - Country:US
Practice Address - Phone:979-265-9653
Practice Address - Fax:979-265-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0882581-01Medicaid
TXAMB060Medicare ID - Type UnspecifiedMEDICARE ASSIGNED #