Provider Demographics
NPI:1679594584
Name:CITY OF BONHAM
Entity type:Organization
Organization Name:CITY OF BONHAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-640-4191
Mailing Address - Street 1:2509 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-2134
Mailing Address - Country:US
Mailing Address - Phone:903-583-3731
Mailing Address - Fax:903-640-4941
Practice Address - Street 1:2509 N CENTER ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2134
Practice Address - Country:US
Practice Address - Phone:903-583-3731
Practice Address - Fax:903-640-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3004723416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB635OtherBC/BS OF TEXAS
TX152654301Medicaid
TX590015424Medicare PIN
TXAMB635OtherBC/BS OF TEXAS