Provider Demographics
NPI:1619082211
Name:NAVAJO NATION EMS
Entity Type:Organization
Organization Name:NAVAJO NATION EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT MANAGER III
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-871-6410
Mailing Address - Street 1:PO BOX #3360
Mailing Address - Street 2:
Mailing Address - City:WINDOW ROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86515-3360
Mailing Address - Country:US
Mailing Address - Phone:928-871-6410
Mailing Address - Fax:928-871-7789
Practice Address - Street 1:MORGAN BLVD (BEHIND POLICE DEPARTMENT)
Practice Address - Street 2:
Practice Address - City:WINDOW ROCK
Practice Address - State:AZ
Practice Address - Zip Code:86515-3360
Practice Address - Country:US
Practice Address - Phone:928-871-6410
Practice Address - Fax:928-871-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR3129OtherMEDICAID
AZ07209101Medicaid
NM=========OtherMEDICARE
NM=========OtherMEDICARE