Provider Demographics
NPI:1386638930
Name:CITY OF BISBEE AMBULANCE
Entity Type:Organization
Organization Name:CITY OF BISBEE AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE BILLING TECH
Authorized Official - Prefix:
Authorized Official - First Name:DAVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-378-3276
Mailing Address - Street 1:118 ARIZONA ST
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-1800
Mailing Address - Country:US
Mailing Address - Phone:520-378-3276
Mailing Address - Fax:520-378-0227
Practice Address - Street 1:118 ARIZONA ST
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-1800
Practice Address - Country:US
Practice Address - Phone:520-378-3276
Practice Address - Fax:520-378-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3416L0300X3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ590005827OtherRR MEDICARE
AZAZ0151300OtherBCBS
AZ241619800OtherDEPT OF LABOR
AZ073255Medicaid