Provider Demographics
NPI:1821133745
Name:DAISY MOUNTAIN FIRE DISTRICT
Entity Type:Organization
Organization Name:DAISY MOUNTAIN FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-465-7400
Mailing Address - Street 1:41018 N DAISY MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4615
Mailing Address - Country:US
Mailing Address - Phone:623-465-7400
Mailing Address - Fax:623-465-7632
Practice Address - Street 1:41018 N DAISY MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086
Practice Address - Country:US
Practice Address - Phone:623-465-7400
Practice Address - Fax:623-465-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1053416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAY6321OtherHEALTHNET
AZAZ0151270OtherBLUE CROSS BLUE SHIELD
AZ375479Medicaid
AZAZ01160Medicare ID - Type UnspecifiedTRADING PARTNER
AZAZ0151270OtherBLUE CROSS BLUE SHIELD