Provider Demographics
NPI:1336169192
Name:CITY OF VICTORIA
Entity Type:Organization
Organization Name:CITY OF VICTORIA
Other - Org Name:VICTORIA EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-572-6600
Mailing Address - Street 1:606 E GOODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6846
Mailing Address - Country:US
Mailing Address - Phone:361-572-6600
Mailing Address - Fax:361-572-9701
Practice Address - Street 1:606 E GOODWIN AVE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6846
Practice Address - Country:US
Practice Address - Phone:361-572-6600
Practice Address - Fax:361-572-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2350063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086222901Medicaid
TX501201OtherBC/BS OF TEXAS
TX501201OtherBC/BS OF TEXAS
TX590445113Medicare PIN