1710071410 NPI number — BULLHEAD CITY FIRE DEPARTMENT

Table of content: (NPI 1710071410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710071410 NPI number — BULLHEAD CITY FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BULLHEAD CITY 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:
1710071410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1260 HANCOCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BULLHEAD CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86442-5906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-758-3971
Provider Business Mailing Address Fax Number:
928-763-3297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1260 HANCOCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BULLHEAD CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86442-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-758-3971
Provider Business Practice Location Address Fax Number:
928-763-3297
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOUTHEY
Authorized Official First Name:
RICK
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
928-758-3971

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  EMS 2767 , 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: 070342 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3288705 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0151570 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: XMT004800 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003288705 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZBCF-SWT . This is a "OTHER INSURANCE PROVIDERS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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