Provider Demographics
NPI:1861496473
Name:CITY OF THORNDALE
Entity Type:Organization
Organization Name:CITY OF THORNDALE
Other - Org Name:THORNDALE VOLUNTEER EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-898-2523
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76577-0308
Mailing Address - Country:US
Mailing Address - Phone:512-898-2523
Mailing Address - Fax:816-431-4973
Practice Address - Street 1:105 N MAIN
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:TX
Practice Address - Zip Code:76577
Practice Address - Country:US
Practice Address - Phone:512-898-2523
Practice Address - Fax:816-431-4973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1661001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX502598OtherBCBS TX
TX167052301Medicaid
TX502598Medicare ID - Type Unspecified