Provider Demographics
NPI:1659765329
Name:CITY OF SOMERTON
Entity Type:Organization
Organization Name:CITY OF SOMERTON
Other - Org Name:SOMERTON EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-722-7376
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-0638
Mailing Address - Country:US
Mailing Address - Phone:928-722-7376
Mailing Address - Fax:928-722-7315
Practice Address - Street 1:445 E MAIN ST.
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350
Practice Address - Country:US
Practice Address - Phone:928-722-7376
Practice Address - Fax:928-722-7315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1649301169OtherNPI