Provider Demographics
NPI:1184762858
Name:CITY OF ROANOKE
Entity type:Organization
Organization Name:CITY OF ROANOKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-491-2301
Mailing Address - Street 1:PO BOX 495548
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75049-5548
Mailing Address - Country:US
Mailing Address - Phone:214-340-2650
Mailing Address - Fax:214-503-7135
Practice Address - Street 1:201 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-3752
Practice Address - Country:US
Practice Address - Phone:214-340-2650
Practice Address - Fax:214-503-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0570673416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX507100OtherBLUE CROSS BLUE SHIELD
TX590012425OtherRAILROAD MEDICARE
TX000483001Medicaid
TX507100OtherBLUE CROSS BLUE SHIELD