Provider Demographics
NPI:1710071410
Name:BULLHEAD CITY FIRE DEPARTMENT
Entity Type:Organization
Organization Name:BULLHEAD CITY FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHEY
Authorized Official - Suffix:
Authorized Official - Credentials:CHIEF
Authorized Official - Phone:928-758-3971
Mailing Address - Street 1:1260 HANCOCK RD
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5906
Mailing Address - Country:US
Mailing Address - Phone:928-758-3971
Mailing Address - Fax:928-763-3297
Practice Address - Street 1:1260 HANCOCK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5906
Practice Address - Country:US
Practice Address - Phone:928-758-3971
Practice Address - Fax:928-763-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZEMS 27673416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070342Medicaid
NV3288705Medicaid
AZAZ0151570OtherBLUE CROSS/BLUE SHIELD
CAXMT004800Medicaid
NV003288705Medicaid
AZAZBCF-SWTOtherOTHER INSURANCE PROVIDERS
AZZ0000RFBCLMedicare ID - Type UnspecifiedMEDICARE
AZ070342Medicaid