Provider Demographics
NPI:1659488922
Name:VERDE VALLEY AMBULANCE CO., INC.
Entity Type:Organization
Organization Name:VERDE VALLEY AMBULANCE CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGFELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-634-7750
Mailing Address - Street 1:PO BOX 1477
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-1477
Mailing Address - Country:US
Mailing Address - Phone:928-634-7750
Mailing Address - Fax:
Practice Address - Street 1:345 E MINGUS AVE
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3670
Practice Address - Country:US
Practice Address - Phone:928-634-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCON493416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070061Medicaid
AZZ=========Medicare ID - Type UnspecifiedPROVIDER NUMBER