Provider Demographics
NPI:1689721367
Name:BLUE RIDGE FIRE DISTRICT
Entity Type:Organization
Organization Name:BLUE RIDGE FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-477-2751
Mailing Address - Street 1:5023 ENCHANTED LANE
Mailing Address - Street 2:
Mailing Address - City:HAPPY JACK
Mailing Address - State:AZ
Mailing Address - Zip Code:86024
Mailing Address - Country:US
Mailing Address - Phone:928-477-2751
Mailing Address - Fax:928-477-2765
Practice Address - Street 1:5023 ENCHANTED LANE
Practice Address - Street 2:
Practice Address - City:HAPPY JACK
Practice Address - State:AZ
Practice Address - Zip Code:86024
Practice Address - Country:US
Practice Address - Phone:928-477-2751
Practice Address - Fax:928-477-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0922020OtherBCBSAZ
AZ106049Medicare PIN