Provider Demographics
NPI:1194728402
Name:CITY OF GRAND PRAIRIE
Entity type:Organization
Organization Name:CITY OF GRAND PRAIRIE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-237-8388
Mailing Address - Street 1:1525 ARKANSAS LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7401
Mailing Address - Country:US
Mailing Address - Phone:972-237-8300
Mailing Address - Fax:972-237-8309
Practice Address - Street 1:1525 ARKANSAS LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7401
Practice Address - Country:US
Practice Address - Phone:972-237-8300
Practice Address - Fax:972-237-8309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300276341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB559OtherCOMMERCIAL INSURANCE
TX000746001Medicaid
TX590014260OtherRAILROAD MEDICARE