Provider Demographics
NPI:1730186636
Name:CITY OF KERRVILLE
Entity type:Organization
Organization Name:CITY OF KERRVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-258-1206
Mailing Address - Street 1:87 CORONADO DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4343
Mailing Address - Country:US
Mailing Address - Phone:830-895-9806
Mailing Address - Fax:830-257-6705
Practice Address - Street 1:87 CORONADO DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4343
Practice Address - Country:US
Practice Address - Phone:830-895-9806
Practice Address - Fax:830-257-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1330113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0194271OtherDEPT OF LABOR & INDUSTRIE
TX617580OtherBCBS OF VIRGINIA
TX088239101Medicaid
TX088239101Medicaid
TX517656Medicare ID - Type Unspecified
TX088239101Medicaid