Provider Demographics
NPI:1255415188
Name:CITY OF WICHITA FALLS
Entity type:Organization
Organization Name:CITY OF WICHITA FALLS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-761-7805
Mailing Address - Street 1:1700 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-2113
Mailing Address - Country:US
Mailing Address - Phone:940-761-7805
Mailing Address - Fax:940-767-5242
Practice Address - Street 1:1700 3RD ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-2113
Practice Address - Country:US
Practice Address - Phone:940-761-7805
Practice Address - Fax:940-767-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1364101-06Medicaid
TX1364101-04Medicaid
TX1364101-07Medicaid
TX1364101-08Medicaid
TX1364101-08Medicaid
TX1364101-05Medicaid
TXPH0018Medicare ID - Type UnspecifiedMEDICARE SHOTS FLU/PNEU
TX1364101-10Medicaid
TX1364101-03Medicaid
TX1364101-05Medicaid
TXPH0018Medicare ID - Type UnspecifiedMEDICARE SHOTS FLU/PNEU