Provider Demographics
NPI:1215930672
Name:CITY OF BENBROOK
Entity type:Organization
Organization Name:CITY OF BENBROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-249-1727
Mailing Address - Street 1:PO BOX 26569
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-0569
Mailing Address - Country:US
Mailing Address - Phone:817-249-3000
Mailing Address - Fax:817-249-0884
Practice Address - Street 1:528 MERCEDES ST
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2521
Practice Address - Country:US
Practice Address - Phone:817-249-1727
Practice Address - Fax:817-249-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2200223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086550301Medicaid
TX504535Medicare ID - Type UnspecifiedAMBULANCE PART B