Provider Demographics
NPI:1710036405
Name:PIMA AGENCY
Entity Type:Organization
Organization Name:PIMA AGENCY
Other - Org Name:AK-CHIN FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-568-1316
Mailing Address - Street 1:45401 W FARRELL RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-3828
Mailing Address - Country:US
Mailing Address - Phone:520-568-1300
Mailing Address - Fax:520-568-1301
Practice Address - Street 1:45401 W FARRELL RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-3828
Practice Address - Country:US
Practice Address - Phone:520-568-1300
Practice Address - Fax:520-568-1301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIMA AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ150178Medicaid
AZ150178Medicaid