1700807625 NPI number — CITY OF KENNEDALE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700807625 NPI number — CITY OF KENNEDALE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF KENNEDALE
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:
KENNEDALE 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:
1700807625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 MUNICIPAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEDALE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76060-2249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-985-2150
Provider Business Mailing Address Fax Number:
817-483-0182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CLOVER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEDALE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76060-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-561-2237
Provider Business Practice Location Address Fax Number:
817-561-2183
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCMURRAY
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
817-985-2150

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  220046 , 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: 507134 . This is a "BC/BS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000158801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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