Provider Demographics
NPI:1255339347
Name:CITY OF EARTH
Entity type:Organization
Organization Name:CITY OF EARTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-257-2111
Mailing Address - Street 1:P.O. BOX 10
Mailing Address - Street 2:
Mailing Address - City:EARTH
Mailing Address - State:TX
Mailing Address - Zip Code:79031-0010
Mailing Address - Country:US
Mailing Address - Phone:806-257-2111
Mailing Address - Fax:806-257-2245
Practice Address - Street 1:202 EAST MAIN
Practice Address - Street 2:
Practice Address - City:EARTH
Practice Address - State:TX
Practice Address - Zip Code:79031-0010
Practice Address - Country:US
Practice Address - Phone:806-257-3415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
TX140006341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000118201Medicaid
TX506583Medicare ID - Type UnspecifiedID # FOR MEDICARE