Provider Demographics
NPI:1205985298
Name:PINETOP VOLUNTEER FIRE DISTRICT
Entity type:Organization
Organization Name:PINETOP VOLUNTEER FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYNN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:LONGENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-368-6799
Mailing Address - Street 1:1845 S PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-8064
Mailing Address - Country:US
Mailing Address - Phone:928-367-2199
Mailing Address - Fax:
Practice Address - Street 1:1845 S PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935-8064
Practice Address - Country:US
Practice Address - Phone:928-367-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ963416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ072710Medicaid
AZ=========Medicare ID - Type Unspecified