1801873104 NPI number — TRI CITY FIRE DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801873104 NPI number — TRI CITY FIRE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI CITY FIRE DISTRICT
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:
6
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:
1801873104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 63068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85082-3068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-437-1431
Provider Business Mailing Address Fax Number:
602-437-8436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4280 E BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYPOOL
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-473-2362
Provider Business Practice Location Address Fax Number:
928-473-2991
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
OLSEN
Authorized Official First Name:
MARCO
Authorized Official Middle Name:
R
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
928-473-2362

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  126 , 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: 748717 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0151790 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P00033704 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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