Provider Demographics
NPI:1689611238
Name:CITY OF ST.JOHNS
Entity Type:Organization
Organization Name:CITY OF ST.JOHNS
Other - Org Name:ST. JOHNS EMERGENCY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE DIRECTOR / CITY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIGELOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-337-4517
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-0455
Mailing Address - Country:US
Mailing Address - Phone:928-337-4517
Mailing Address - Fax:928-337-2195
Practice Address - Street 1:375 S. WASHINGTON
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936
Practice Address - Country:US
Practice Address - Phone:928-337-3070
Practice Address - Fax:928-337-4786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF ST. JOHNS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM907030S7Medicaid
AZ0702S1Medicaid
AZ0000RFBCTMedicare ID - Type Unspecified