Provider Demographics
NPI:1740258292
Name:CITY OF JACINTO CITY
Entity type:Organization
Organization Name:CITY OF JACINTO CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LON
Authorized Official - Middle Name:
Authorized Official - Last Name:SQUYRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-674-1841
Mailing Address - Street 1:PO BOX 691363
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-1363
Mailing Address - Country:US
Mailing Address - Phone:281-397-0397
Mailing Address - Fax:281-397-0007
Practice Address - Street 1:1126 MERCURY DRIVE
Practice Address - Street 2:
Practice Address - City:JACINTO CITY
Practice Address - State:TX
Practice Address - Zip Code:77029
Practice Address - Country:US
Practice Address - Phone:713-674-1841
Practice Address - Fax:713-673-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000010001Medicaid
LA1635715Medicaid
590005192OtherRR MEDICARE
590005192OtherRR MEDICARE
LA1635715Medicaid