Provider Demographics
NPI:1912229444
Name:WYLIE FIRE-RESCUE
Entity type:Organization
Organization Name:WYLIE FIRE-RESCUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-442-8110
Mailing Address - Street 1:801A SOUTH HWY. 78
Mailing Address - Street 2:204
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098
Mailing Address - Country:US
Mailing Address - Phone:972-442-8110
Mailing Address - Fax:972-442-8113
Practice Address - Street 1:801A SOUTH HWY. 78
Practice Address - Street 2:204
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098
Practice Address - Country:US
Practice Address - Phone:972-442-8110
Practice Address - Fax:972-442-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3002623416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX300262OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES EMS PROVIDER NUMBER