Provider Demographics
NPI:1205883717
Name:SOUTHWEST AMBULANCE OF TUCSON INC
Entity type:Organization
Organization Name:SOUTHWEST AMBULANCE OF TUCSON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DORN
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 1:3759 N COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-6911
Practice Address - Country:US
Practice Address - Phone:520-544-4800
Practice Address - Fax:520-622-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
AZEMS40573416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070110Medicaid
AZ1Z6647OtherHEALTHNET PIN
AZ5002371OtherAETNA PIN
AZVALUE OPTIONSOther2189001
AZ5002371OtherAETNA PIN
AZ1Z6647OtherHEALTHNET PIN
AZ5002371OtherAETNA PIN
AZ070110Medicaid