Provider Demographics
NPI:1063415974
Name:CITY OF LA PORTE
Entity type:Organization
Organization Name:CITY OF LA PORTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOMINEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-470-0051
Mailing Address - Street 1:PO BOX 180446
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-0446
Mailing Address - Country:US
Mailing Address - Phone:972-602-2060
Mailing Address - Fax:800-353-2196
Practice Address - Street 1:10428 SPENCER HIGHWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6215
Practice Address - Country:US
Practice Address - Phone:281-471-9244
Practice Address - Fax:281-471-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010773416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107652301Medicaid
TX501176Medicare ID - Type UnspecifiedPROVIDER ID