Provider Demographics
NPI:1477602142
Name:SALT RIVER PIMA-MARICOPA INDIAN
Entity Type:Organization
Organization Name:SALT RIVER PIMA-MARICOPA INDIAN
Other - Org Name:SALT RIVER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-362-7922
Mailing Address - Street 1:10005 E OSBORN RD
Mailing Address - Street 2:BLDG 9
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85256-4019
Mailing Address - Country:US
Mailing Address - Phone:480-362-7923
Mailing Address - Fax:480-362-7998
Practice Address - Street 1:10005 E OSBORN RD
Practice Address - Street 2:BLDG 9
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85256-4019
Practice Address - Country:US
Practice Address - Phone:480-362-7923
Practice Address - Fax:480-362-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110601Medicaid
AZZRGAACMedicare PIN
AZZRGAACMedicare ID - Type Unspecified