Provider Demographics
NPI:1790763522
Name:CITY OF CLOVIS
Entity Type:Organization
Organization Name:CITY OF CLOVIS
Other - Org Name:CLOVIS FIRE DEPARTMENT EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICCILLO
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING SPECIALIST
Authorized Official - Phone:575-763-9228
Mailing Address - Street 1:320 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-7471
Mailing Address - Country:US
Mailing Address - Phone:575-763-9228
Mailing Address - Fax:
Practice Address - Street 1:320 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-7471
Practice Address - Country:US
Practice Address - Phone:575-763-9228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPRC12897341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2504021Medicare PIN