Provider Demographics
NPI:1306839253
Name:CITY OF SANTA ROSA
Entity Type:Organization
Organization Name:CITY OF SANTA ROSA
Other - Org Name:SANTA ROSA AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS CLERK
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-472-0367
Mailing Address - Street 1:PO BOX 18230
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-0230
Mailing Address - Country:US
Mailing Address - Phone:505-472-3404
Mailing Address - Fax:
Practice Address - Street 1:141 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:NM
Practice Address - Zip Code:88435-2369
Practice Address - Country:US
Practice Address - Phone:505-472-3404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPRC134783416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR0852Medicaid
NM2504782Medicare PIN