Provider Demographics
NPI:1063567576
Name:CITY OF LEAGUE CITY
Entity type:Organization
Organization Name:CITY OF LEAGUE CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-554-1207
Mailing Address - Street 1:PO BOX 269110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-9110
Mailing Address - Country:US
Mailing Address - Phone:916-381-6552
Mailing Address - Fax:916-381-5047
Practice Address - Street 1:555 W WALKER ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3853
Practice Address - Country:US
Practice Address - Phone:281-554-1207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10001483416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202903502Medicaid
TXAMB797Medicare PIN