Provider Demographics
NPI:1417006867
Name:SUNSITES PEARCE FIRE DISTRICT
Entity Type:Organization
Organization Name:SUNSITES PEARCE FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC BOOKKEEPER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-826-3645
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:PEARCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85625-0412
Mailing Address - Country:US
Mailing Address - Phone:520-826-3645
Mailing Address - Fax:520-826-3586
Practice Address - Street 1:105 N TRACY ROAD
Practice Address - Street 2:
Practice Address - City:PEARCE
Practice Address - State:AZ
Practice Address - Zip Code:85625-0412
Practice Address - Country:US
Practice Address - Phone:520-826-3645
Practice Address - Fax:520-826-3586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33146L00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8100606OtherPACIFICARE
AZ8100606OtherPACIFICARE