Provider Demographics
NPI:1801873609
Name:CITY OF SUDAN
Entity type:Organization
Organization Name:CITY OF SUDAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMT-I BILLING COORDINTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT I
Authorized Official - Phone:806-638-9987
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:SUDAN
Mailing Address - State:TX
Mailing Address - Zip Code:79371-0491
Mailing Address - Country:US
Mailing Address - Phone:806-227-2113
Mailing Address - Fax:806-227-2114
Practice Address - Street 1:101 HORNET DRIVE
Practice Address - Street 2:
Practice Address - City:SUDAN
Practice Address - State:TX
Practice Address - Zip Code:79371
Practice Address - Country:US
Practice Address - Phone:806-227-2113
Practice Address - Fax:806-227-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1400073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000643901Medicaid
TX000643901Medicaid