Provider Demographics
NPI:1154322980
Name:WHETSTONE FIRE DISTRICT
Entity Type:Organization
Organization Name:WHETSTONE FIRE DISTRICT
Other - Org Name:WHETSTONE FIRE DISTRICT AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-456-1717
Mailing Address - Street 1:2422 N FIREHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:HUACHUCA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85616-9623
Mailing Address - Country:US
Mailing Address - Phone:520-456-1717
Mailing Address - Fax:520-456-0120
Practice Address - Street 1:2422 N FIREHOUSE LN
Practice Address - Street 2:
Practice Address - City:HUACHUCA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85616-9623
Practice Address - Country:US
Practice Address - Phone:520-456-1717
Practice Address - Fax:520-456-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ590014505OtherRAILROAD MEDICARE
AZ605159200OtherDEPT OF LABOR
AZAZ0151990OtherBLUE CROSS BLUE SHIELD
AZAY6585OtherHEALTH NET
AZ396798Medicaid
AZ590014505OtherRAILROAD MEDICARE