1154322980 NPI number — WHETSTONE FIRE DISTRICT

Table of content: (NPI 1154322980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154322980 NPI number — WHETSTONE FIRE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHETSTONE 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:
1154322980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2422 N FIREHOUSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUACHUCA CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85616-9623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-456-1717
Provider Business Mailing Address Fax Number:
520-456-0120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2422 N FIREHOUSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUACHUCA CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85616-9623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-456-1717
Provider Business Practice Location Address Fax Number:
520-456-0120
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BIDON
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
520-456-1717

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  119 , 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: 590014505 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 605159200 . This is a "DEPT OF LABOR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0151990 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AY6585 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 396798 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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