Provider Demographics
NPI:1093916454
Name:GRAPEVINE MESA FIRE DISTRICT
Entity Type:Organization
Organization Name:GRAPEVINE MESA FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:L
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-564-2777
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:30250 N STILLWATER DR
Mailing Address - City:MEADVIEW
Mailing Address - State:AZ
Mailing Address - Zip Code:86444-0068
Mailing Address - Country:US
Mailing Address - Phone:928-564-2777
Mailing Address - Fax:928-564-2499
Practice Address - Street 1:30250 N. STILLWATER DR
Practice Address - Street 2:
Practice Address - City:MEADVIEW
Practice Address - State:AZ
Practice Address - Zip Code:86444-0068
Practice Address - Country:US
Practice Address - Phone:928-564-2777
Practice Address - Fax:928-564-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ130 EMS30563416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport