Provider Demographics
NPI:1083751176
Name:CITY OF PAGE
Entity Type:Organization
Organization Name:CITY OF PAGE
Other - Org Name:CITY OF PAGE FIRE DEPARTMENT .AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:402-572-4019
Mailing Address - Street 1:PO BOX 641880
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7880
Mailing Address - Country:US
Mailing Address - Phone:402-572-4017
Mailing Address - Fax:402-965-8594
Practice Address - Street 1:808 COPPERMINE ROAD
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-1180
Practice Address - Country:US
Practice Address - Phone:928-645-4340
Practice Address - Fax:928-645-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ590008646OtherRR MEDICARE
AZZ128585OtherMEDICARE
AZAZ 0151600OtherBLUE CROSS BLUE SHIELD
UT1083751176OtherUT MEDICAID
AZ113192Medicaid