Provider Demographics
NPI:1831155647
Name:CITY OF BRYAN
Entity type:Organization
Organization Name:CITY OF BRYAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-209-5970
Mailing Address - Street 1:P.O. BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-1000
Mailing Address - Country:US
Mailing Address - Phone:979-209-5080
Mailing Address - Fax:979-209-5095
Practice Address - Street 1:300 SOUTH TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-3226
Practice Address - Country:US
Practice Address - Phone:979-209-5080
Practice Address - Fax:979-209-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0210063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000117401Medicaid
TX000117401Medicaid