Provider Demographics
NPI:1982716056
Name:CITY OF SOUTHLAKE TEX
Entity Type:Organization
Organization Name:CITY OF SOUTHLAKE TEX
Other - Org Name:SOUTHLAKE DEPT OF PUBLIC SAFETY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF, SOUTHLAKE DPS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:817-748-8146
Mailing Address - Street 1:600 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7669
Mailing Address - Country:US
Mailing Address - Phone:817-748-8328
Mailing Address - Fax:817-748-8048
Practice Address - Street 1:667 N CARROLL AVE
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6412
Practice Address - Country:US
Practice Address - Phone:817-748-8328
Practice Address - Fax:817-748-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2200283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX513783OtherBC/BS
TX513783Medicare PIN