1083664999 NPI number — MOHAVE VALLEY FIRE DEPARTMENT

Table of content: (NPI 1083664999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083664999 NPI number — MOHAVE VALLEY FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAVE VALLEY FIRE DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083664999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1451 WILLOW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOHAVE VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86440-8542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-768-9113
Provider Business Mailing Address Fax Number:
928-768-9119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1451 WILLOW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOHAVE VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86440-8542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-768-9113
Provider Business Practice Location Address Fax Number:
928-768-9119
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SORENSEN
Authorized Official First Name:
MEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
928-768-9113

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  38 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GA383A2 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: XMTE05650 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0052407 . This is a "KAISER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 070441 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144251-00 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ 0151130 . This is a "BC/BS OF ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: USAAMB000 . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AM FS 0398640 . This is a "BLUE CROSS OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 003289055 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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