Provider Demographics
NPI:1982655163
Name:CITY OF VERNON
Entity Type:Organization
Organization Name:CITY OF VERNON
Other - Org Name:CITY OF VERNON FIRE/EMS DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-553-1782
Mailing Address - Street 1:PO BOX 1469
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-1469
Mailing Address - Country:US
Mailing Address - Phone:855-626-9660
Mailing Address - Fax:833-953-0588
Practice Address - Street 1:4109 WILBARGER STREET
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3137
Practice Address - Country:US
Practice Address - Phone:940-553-1782
Practice Address - Fax:940-552-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2440023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000068901Medicaid
TX505612Medicare PIN