Provider Demographics
NPI:1134197692
Name:CITY OF BOVINA
Entity type:Organization
Organization Name:CITY OF BOVINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PARAMEDIC
Authorized Official - Phone:806-251-1167
Mailing Address - Street 1:P.O. BOX 720
Mailing Address - Street 2:
Mailing Address - City:BOVINA
Mailing Address - State:TX
Mailing Address - Zip Code:79009-0720
Mailing Address - Country:US
Mailing Address - Phone:806-251-1116
Mailing Address - Fax:806-251-1805
Practice Address - Street 1:205 NORTH STREET
Practice Address - Street 2:
Practice Address - City:BOVINA
Practice Address - State:TX
Practice Address - Zip Code:79009-0720
Practice Address - Country:US
Practice Address - Phone:806-251-1116
Practice Address - Fax:806-251-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000086101Medicaid
C16746Medicare UPIN
TX000086101Medicaid
P00157580Medicare ID - Type UnspecifiedRAILROAD