Provider Demographics
NPI:1942393517
Name:FORT MOJAVE MESA FIRE DEPARTMENT
Entity Type:Organization
Organization Name:FORT MOJAVE MESA FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BATTALION CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-768-9181
Mailing Address - Street 1:2230 JOY LN
Mailing Address - Street 2:P.O. BOX 8488
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6625
Mailing Address - Country:US
Mailing Address - Phone:928-768-9181
Mailing Address - Fax:928-768-8434
Practice Address - Street 1:2230 JOY LN
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6625
Practice Address - Country:US
Practice Address - Phone:928-768-9181
Practice Address - Fax:928-768-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ823416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071407Medicaid
AZ8886341300OtherKAISER FOUNDATION
AZAZ0151150OtherBC/BS/AZ
AZXMT002750Medicaid
AZ3288114Medicaid
AZ003288081Medicaid
AZ014822-0001OtherPACIFICARE
AZAZ626073OtherOXFORD
AZC09900004351OtherSIERRA HEALTH
AZC09900004351OtherSIERRA HEALTH
AZAZ626073OtherOXFORD
AZ003288081Medicaid