Provider Demographics
NPI:1851597538
Name:CITY OF KIRBY
Entity Type:Organization
Organization Name:CITY OF KIRBY
Other - Org Name:KIRBY FIRE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAIRD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:EMS-CAPTAIN
Authorized Official - Phone:210-661-2612
Mailing Address - Street 1:112 BAUMAN ST
Mailing Address - Street 2:
Mailing Address - City:KIRBY
Mailing Address - State:TX
Mailing Address - Zip Code:78219-1004
Mailing Address - Country:US
Mailing Address - Phone:210-661-2612
Mailing Address - Fax:210-661-8074
Practice Address - Street 1:5560 DUFFEK
Practice Address - Street 2:
Practice Address - City:KIRBY
Practice Address - State:TX
Practice Address - Zip Code:78219
Practice Address - Country:US
Practice Address - Phone:210-661-2612
Practice Address - Fax:210-661-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015026341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX508095Medicare PIN