Provider Demographics
NPI:1144545419
Name:CITY OF ELY
Entity type:Organization
Organization Name:CITY OF ELY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:775-289-6633
Mailing Address - Street 1:501 MILL ST
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-1940
Mailing Address - Country:US
Mailing Address - Phone:775-289-2430
Mailing Address - Fax:775-289-1463
Practice Address - Street 1:1780 GREAT BASIN BLVD
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-3138
Practice Address - Country:US
Practice Address - Phone:775-289-6633
Practice Address - Fax:775-289-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1144545419Medicaid
NV1144545419Medicaid