Provider Demographics
NPI:1801873104
Name:TRI CITY FIRE DISTRICT
Entity type:Organization
Organization Name:TRI CITY FIRE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-473-2362
Mailing Address - Street 1:PO BOX 63068
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-3068
Mailing Address - Country:US
Mailing Address - Phone:602-437-1431
Mailing Address - Fax:602-437-8436
Practice Address - Street 1:4280 E BROADWAY
Practice Address - Street 2:
Practice Address - City:CLAYPOOL
Practice Address - State:AZ
Practice Address - Zip Code:85532
Practice Address - Country:US
Practice Address - Phone:928-473-2362
Practice Address - Fax:928-473-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ126341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ748717Medicaid
AZAZ0151790OtherBCBS
AZP00033704OtherRR MEDICARE
AZP00033704OtherRR MEDICARE
AZZ74842Medicare ID - Type Unspecified