Provider Demographics
NPI:1770621492
Name:CITY OF MESQUITE
Entity type:Organization
Organization Name:CITY OF MESQUITE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:972-216-6465
Mailing Address - Street 1:1515 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2359
Mailing Address - Country:US
Mailing Address - Phone:972-216-6267
Mailing Address - Fax:972-329-8315
Practice Address - Street 1:1515 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2359
Practice Address - Country:US
Practice Address - Phone:972-216-6267
Practice Address - Fax:972-329-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0570303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086455501Medicaid
TX503832OtherBLUE CROSS BLUE SHIELD
TX590539394OtherRAILROAD MEDICARE
TX503832Medicare PIN