1801873104 NPI number — TRI CITY FIRE DISTRICT

Table of content: (NPI 1801873104)

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:
TRI CITY FIRE DISTRICT AMBULANCE SERVICE
Provider Other Organization Name Type Code:
3
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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