Provider Demographics
NPI:1649301169
Name:CITY OF SOMERTON
Entity type:Organization
Organization Name:CITY OF SOMERTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-722-7373
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350
Mailing Address - Country:US
Mailing Address - Phone:928-722-7376
Mailing Address - Fax:928-722-7315
Practice Address - Street 1:445 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350
Practice Address - Country:US
Practice Address - Phone:928-722-7376
Practice Address - Fax:928-722-7315
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF SOMERTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071259OtherAHCCCS
AZZ0000RFBGQMedicare ID - Type Unspecified