City of Liberty

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

146011 Issued in TX

Legal business name

CITY OF LIBERTY

Practice address

1912 Lakeland
Liberty, TX 77575-7745

Phone

(936) 336-3922

Fax

(936) 336-5417

NPI assigned

Oct 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Misty Leigh Dulaney

Title

Administrative Assistant

Phone

(936) 336-3922

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263254400000",
    "number": "1588747331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 LAKELAND DR",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775753855",
            "telephone_number": "936-336-3922",
            "fax_number": "936-336-5417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 LAKELAND",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775757745",
            "telephone_number": "936-336-3922",
            "fax_number": "936-336-5417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF LIBERTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2010-01-12",
        "status": "A",
        "authorized_official_last_name": "DULANEY",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "936-336-3922"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "TX",
            "license": "146011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "505441",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "088195501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Liberty, TX
• Land Ambulance in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.