Provider Demographics
NPI:1770945594
Name:TOWN OF QUEEN CREEK
Entity type:Organization
Organization Name:TOWN OF QUEEN CREEK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-358-3372
Mailing Address - Street 1:22358 S ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-9311
Mailing Address - Country:US
Mailing Address - Phone:480-358-3372
Mailing Address - Fax:
Practice Address - Street 1:22358 S ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9311
Practice Address - Country:US
Practice Address - Phone:480-358-3372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZG532HG341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance