Provider Demographics
NPI:1679532535
Name:SIERRA VISTA FRY FIRE DISTRICT
Entity Type:Organization
Organization Name:SIERRA VISTA FRY FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:520-378-3276
Mailing Address - Street 1:4817 S APACHE AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-9702
Mailing Address - Country:US
Mailing Address - Phone:520-378-3276
Mailing Address - Fax:520-378-0227
Practice Address - Street 1:4817 S APACHE AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650
Practice Address - Country:US
Practice Address - Phone:520-378-3276
Practice Address - Fax:520-378-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071043-001Medicaid
AZZ=========Medicare ID - Type Unspecified