1861962367 NPI number — COPPER CANYON FIRE & MEDICAL DISTRICT

Table of content: (NPI 1861962367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861962367 NPI number — COPPER CANYON FIRE & MEDICAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COPPER CANYON FIRE & MEDICAL 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:
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:
1861962367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1543
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMP VERDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86322-1543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-567-9401
Provider Business Mailing Address Fax Number:
928-567-3919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
494 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP VERDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86322-7256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-567-9401
Provider Business Practice Location Address Fax Number:
928-567-3919
Provider Enumeration Date:
11/28/2018

Additional Information

Authorized Official

Authorized Official Last Name:
KELLER
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
928-567-9401

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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