Provider Demographics
NPI:1023055399
Name:TOWN OF TAYLOR
Entity type:Organization
Organization Name:TOWN OF TAYLOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CEP
Authorized Official - Phone:928-536-7900
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85939-0158
Mailing Address - Country:US
Mailing Address - Phone:928-536-7900
Mailing Address - Fax:928-536-6122
Practice Address - Street 1:425 PAPERMILL RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:AZ
Practice Address - Zip Code:85939-0158
Practice Address - Country:US
Practice Address - Phone:928-536-7900
Practice Address - Fax:928-536-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ072562Medicaid
NM000R354SMedicaid
NM000R354SMedicaid