Provider Demographics
NPI:1750407169
Name:CITY OF HOUSTON
Entity type:Organization
Organization Name:CITY OF HOUSTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JERVISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-896-3234
Mailing Address - Street 1:105 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MN
Mailing Address - Zip Code:55943-0667
Mailing Address - Country:US
Mailing Address - Phone:507-896-3234
Mailing Address - Fax:
Practice Address - Street 1:105 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MN
Practice Address - Zip Code:55943
Practice Address - Country:US
Practice Address - Phone:507-895-3234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN39883HOOtherBLUE CROSSE BLUE SHIELD