1679594584 NPI number — CITY OF BONHAM

Table of content: (NPI 1679594584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679594584 NPI number — CITY OF BONHAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BONHAM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BONHAM FIRE DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679594584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2509 N CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONHAM
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75418-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-583-3731
Provider Business Mailing Address Fax Number:
903-640-4941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2509 N CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONHAM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75418-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-583-3731
Provider Business Practice Location Address Fax Number:
903-640-4941
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLS
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
903-640-4191

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  300472 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AMB635 . This is a "BC/BS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 152654301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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