Provider Demographics
NPI:1811041023
Name:CITY OF DEER PARK
Entity Type:Organization
Organization Name:CITY OF DEER PARK
Other - Org Name:EMERGENCY AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:AMBULANCE BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-478-7281
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-0700
Mailing Address - Country:US
Mailing Address - Phone:281-478-7281
Mailing Address - Fax:281-478-7289
Practice Address - Street 1:2211 EAST X STREET
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4293
Practice Address - Country:US
Practice Address - Phone:281-478-7281
Practice Address - Fax:281-478-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000911-01Medicaid
TX505970Other911 EMERGENCY AMBULANCE
TX0000911-01Medicaid