Provider Demographics
NPI:1972652535
Name:FORT MCDOWELL YAVAPAI NATION
Entity Type:Organization
Organization Name:FORT MCDOWELL YAVAPAI NATION
Other - Org Name:FORT MCDOWELL YAVAPAI NATION FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OPENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-789-7520
Mailing Address - Street 1:10755 N FORT MCDOWELL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FORT MCDOWELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85264-3107
Mailing Address - Country:US
Mailing Address - Phone:480-789-7521
Mailing Address - Fax:480-789-7525
Practice Address - Street 1:10755 N FORT MCDOWELL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT MCDOWELL
Practice Address - State:AZ
Practice Address - Zip Code:85264-3107
Practice Address - Country:US
Practice Address - Phone:480-789-7521
Practice Address - Fax:480-789-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ558942Medicaid
Z67965Medicare PIN