Provider Demographics
NPI:1336692342
Name:CITY OF PEORIA
Entity Type:Organization
Organization Name:CITY OF PEORIA
Other - Org Name:PEORIA FIRE MEDICAL DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CHIEF OF EMS
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:OA
Authorized Official - Phone:623-773-7911
Mailing Address - Street 1:8401 W MONROE ST
Mailing Address - Street 2:ATTN: FIRE-MEDICAL DEPARTMENT
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6560
Mailing Address - Country:US
Mailing Address - Phone:623-773-7279
Mailing Address - Fax:623-773-7295
Practice Address - Street 1:8351 W CINNABAR AVE
Practice Address - Street 2:ATTN: FIRE-MEDICAL DEPARTMENT
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-2701
Practice Address - Country:US
Practice Address - Phone:623-773-7279
Practice Address - Fax:623-773-7295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ146341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance