Provider Demographics
NPI:1083664999
Name:MOHAVE VALLEY FIRE DEPARTMENT
Entity Type:Organization
Organization Name:MOHAVE VALLEY FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-768-9113
Mailing Address - Street 1:1451 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:MOHAVE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86440-8542
Mailing Address - Country:US
Mailing Address - Phone:928-768-9113
Mailing Address - Fax:928-768-9119
Practice Address - Street 1:1451 WILLOW DR
Practice Address - Street 2:
Practice Address - City:MOHAVE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86440-8542
Practice Address - Country:US
Practice Address - Phone:928-768-9113
Practice Address - Fax:928-768-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGA383A2Medicaid
CAXMTE05650Medicaid
CA0052407OtherKAISER
AZ070441Medicaid
WY1144251-00Medicaid
AZAZ 0151130OtherBC/BS OF ARIZONA
CAUSAAMB000OtherBLUE SHIELD OF CALIFORNIA
CAAM FS 0398640OtherBLUE CROSS OF CALIFORNIA
NV003289055Medicaid
AKGA383A2Medicaid
AZ0000BGKSNMedicare ID - Type Unspecified
WY1144251-00Medicaid