Provider Demographics
NPI:1538116652
Name:SOUTHWEST AMBULANCE OF CASA GRANDE
Entity Type:Organization
Organization Name:SOUTHWEST AMBULANCE OF CASA GRANDE
Other - Org Name:SWARA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 847102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7102
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:
Practice Address - Street 1:313 W 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4415
Practice Address - Country:US
Practice Address - Phone:520-876-0168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
AZ853416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8144555OtherAETNA PIN
AZPAM130020013OtherMERCY CARE
AZZRFBHROtherTRICARE
AZ187965Medicaid
AZ590009695OtherRR MEDICARE NO
AZAW3082OtherHEALTHNET PIN
AZ2189001Medicaid
AZF01948Medicaid
AZ189030900OtherDEPT OF LABOR
AZF02727OtherPHOENIX HEALTH PLAN
AZF02727Medicaid
AZAZ0152400OtherBCBS PIN
AZF01948Medicaid
AZAW3082OtherHEALTHNET PIN
AZAZ0152400OtherBCBS PIN