Provider Demographics
NPI:1013916618
Name:ELFRIDA FIRE DISTRICT
Entity Type:Organization
Organization Name:ELFRIDA FIRE DISTRICT
Other - Org Name:ELFRIDA AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-642-3749
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:10293 CENTRAL HWY.
Mailing Address - City:ELFRIDA
Mailing Address - State:AZ
Mailing Address - Zip Code:85610-0068
Mailing Address - Country:US
Mailing Address - Phone:520-642-3749
Mailing Address - Fax:520-642-3749
Practice Address - Street 1:10293 N CENTRAL HWY
Practice Address - Street 2:
Practice Address - City:ELFRIDA
Practice Address - State:AZ
Practice Address - Zip Code:85610-0068
Practice Address - Country:US
Practice Address - Phone:520-642-3749
Practice Address - Fax:520-642-3749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZEMS28373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0150560OtherBLUE CROSS BLUE SHIELD
AZ070392OtherAHCCCS
AZAZ0150560OtherBLUE CROSS BLUE SHIELD