1942393517 NPI number — FORT MOJAVE MESA FIRE DEPARTMENT

Table of content: (NPI 1942393517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942393517 NPI number — FORT MOJAVE MESA FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORT MOJAVE MESA 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:
1942393517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2230 JOY LN
Provider Second Line Business Mailing Address:
P.O. BOX 8488
Provider Business Mailing Address City Name:
FORT MOHAVE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86426-6625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-768-9181
Provider Business Mailing Address Fax Number:
928-768-8434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2230 JOY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MOHAVE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86426-6625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-768-9181
Provider Business Practice Location Address Fax Number:
928-768-8434
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BATTALION CHIEF
Authorized Official Telephone Number:
928-768-9181

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  82 , 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: 071407 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8886341300 . This is a "KAISER FOUNDATION" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0151150 . This is a "BC/BS/AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: XMT002750 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3288114 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003288081 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014822-0001 . This is a "PACIFICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ626073 . This is a "OXFORD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: C09900004351 . This is a "SIERRA HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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