Provider Demographics
NPI:1891728465
Name:CITY OF COLLEGE STATION
Entity Type:Organization
Organization Name:CITY OF COLLEGE STATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-764-3745
Mailing Address - Street 1:PO BOX 9960
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-7960
Mailing Address - Country:US
Mailing Address - Phone:979-764-3587
Mailing Address - Fax:
Practice Address - Street 1:300 KRENEK TAP RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-5023
Practice Address - Country:US
Practice Address - Phone:979-764-3705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0210043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0000OtherCHAMPUS VA CENTER
WI0000OtherCHAMPUS FOUNDATION HEALTH
TX000053101Medicaid
TX505305OtherCLAREDON CHIPS PROGRAM
KY8541632OtherAETNA
TX8541632OtherFEDERAL BLUE
TX60054OtherAETNA HEALTH PLANS OF TEX
SC0000OtherCHAMPUS RETIRED MILITARY
VA000053101OtherAMERIGROUP - MEDICAID
TX505305OtherBCBS
NE0009728OtherHARRIS METHODIST HEALTH P
CO95266OtherHARRINGTON BNEFITS SE
TX103014100OtherFIRST CARE HMO
SC0000OtherCHAMPUS RETIRED MILITARY
KY8541632OtherAETNA
TX8541632OtherFEDERAL BLUE
CO95266OtherHARRINGTON BNEFITS SE
KY=========OtherAETNA
TX000053101Medicaid
TX505305Medicare PIN