Provider Demographics
NPI:1598819377
Name:ROSS N DIA
Entity Type:Organization
Organization Name:ROSS N DIA
Other - Org Name:AMERICAN NATIVE MEDICAL TRANSPORT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-284-1321
Mailing Address - Street 1:6021 W POTRILLO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-9669
Mailing Address - Country:US
Mailing Address - Phone:520-579-8171
Mailing Address - Fax:520-579-3515
Practice Address - Street 1:BONITA DRIVE
Practice Address - Street 2:FT. DEFIANCE HOSPITAL
Practice Address - City:FT. DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:520-579-8171
Practice Address - Fax:520-579-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ464199-01Medicaid
AZAZ0152010OtherBLUE CROSS BLUE SHEILD
AZP00085640Medicare ID - Type UnspecifiedMEDICARE RAILROAD
AZ464199-01Medicaid