Provider Demographics
NPI:1073510699
Name:CITY OF NOGALES
Entity Type:Organization
Organization Name:CITY OF NOGALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:MARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-285-5647
Mailing Address - Street 1:777 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2262
Mailing Address - Country:US
Mailing Address - Phone:520-285-5647
Mailing Address - Fax:520-287-2230
Practice Address - Street 1:777 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2262
Practice Address - Country:US
Practice Address - Phone:520-285-5647
Practice Address - Fax:520-287-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071994Medicaid
AZZ0000RFBGLMedicare ID - Type Unspecified