Provider Demographics
NPI:1649337643
Name:CITY OF MESQUITE
Entity type:Organization
Organization Name:CITY OF MESQUITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER REP.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:801-295-9811
Mailing Address - Street 1:DEPT. 8815
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-8815
Mailing Address - Country:US
Mailing Address - Phone:213-614-3049
Mailing Address - Fax:866-575-5490
Practice Address - Street 1:10 E MESQUITE BLVD.
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-4706
Practice Address - Country:US
Practice Address - Phone:702-346-2690
Practice Address - Fax:702-346-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
NV#314341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV1263OtherN.B. B.C/B.S.
CAXMTE06486Medicaid
NV003202331Medicaid
590014513OtherR.R.
NV003202331Medicaid
590006092Medicare PIN
NV0000RCBBHMedicare UPIN
NV=========OtherTRICARE