Provider Demographics
NPI:1134252570
Name:CITY OF EDEN
Entity type:Organization
Organization Name:CITY OF EDEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:325-869-2022
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:TX
Mailing Address - Zip Code:76837-0268
Mailing Address - Country:US
Mailing Address - Phone:325-869-5507
Mailing Address - Fax:325-869-5006
Practice Address - Street 1:102 GORDON ST.
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:TX
Practice Address - Zip Code:76837
Practice Address - Country:US
Practice Address - Phone:325-869-5507
Practice Address - Fax:325-869-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX048002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX048002OtherTEXAS DSHS EMS NUMBER
TX1134252570Medicaid
TX505520Medicare PIN