Basic Information
| Provider Information | |||||||||
| NPI: | 1649362096 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CITY OF ENNIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 220 | ||||||||
| Address2: | |||||||||
| City: | ENNIS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751100220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728751234 | ||||||||
| FaxNumber: | 9728754615 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 S DALLAS ST | ||||||||
| Address2: | |||||||||
| City: | ENNIS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751194747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728751234 | ||||||||
| FaxNumber: | 9728751234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 07/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | HOPKINS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | FIRE CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 9728751234 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 700005 | TX | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 086441501 | 05 | TX | MEDICAID |