Provider Demographics
NPI:1891742417
Name:SOUTHWEST AMBULANCE OF SOUTHEASTERN ARIZONA INC
Entity Type:Organization
Organization Name:SOUTHWEST AMBULANCE OF SOUTHEASTERN ARIZONA INC
Other - Org Name:SOUTHWEST AMBULANCE OF SAFFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 847102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7102
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:
Practice Address - Street 1:209 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2450
Practice Address - Country:US
Practice Address - Phone:928-428-9860
Practice Address - Fax:928-348-9932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8144555OtherAETNA
AZAW3433OtherHEALTHNET PIN
AZP01273233OtherRAILROAD MEDICARE PTAN
AZ158445Medicaid
AZAZ0152410OtherBCBS
AZVALUE OPTIONSOther2189001
AZF11204Medicaid
AZF11204Medicaid
AZ=========OtherPACIFICARE PIN
AZ=========OtherHUMANA
AZ158445Medicaid