Provider Demographics
NPI:1679556211
Name:CITY OF IRAAN
Entity type:Organization
Organization Name:CITY OF IRAAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-639-2952
Mailing Address - Street 1:8300 BISSONNET ST
Mailing Address - Street 2:STE 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3900
Mailing Address - Country:US
Mailing Address - Phone:713-773-4355
Mailing Address - Fax:713-773-4363
Practice Address - Street 1:509 E 6TH ST.
Practice Address - Street 2:
Practice Address - City:IRAAN
Practice Address - State:TX
Practice Address - Zip Code:79744
Practice Address - Country:US
Practice Address - Phone:432-639-2952
Practice Address - Fax:432-639-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186005341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000007701Medicaid
TX501503Medicare ID - Type Unspecified