Provider Demographics
NPI:1811905425
Name:CITY OF SWEETWATER
Entity type:Organization
Organization Name:CITY OF SWEETWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:235-235-4304
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556
Mailing Address - Country:US
Mailing Address - Phone:325-235-4304
Mailing Address - Fax:325-235-8507
Practice Address - Street 1:900 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-4714
Practice Address - Country:US
Practice Address - Phone:325-235-4304
Practice Address - Fax:325-235-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX177004341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000135601Medicaid
TX506830OtherALL OTHER INSURANCE
TX=========OtherALL OTHER INS
TX=========OtherALL OTHER INS