Provider Demographics
NPI:1932624392
Name:COPPER CANYON FIRE AND MEDICAL AUTHORITY
Entity Type:Organization
Organization Name:COPPER CANYON FIRE AND MEDICAL AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-567-9401
Mailing Address - Street 1:PO BOX 1543
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-1543
Mailing Address - Country:US
Mailing Address - Phone:928-779-3720
Mailing Address - Fax:928-213-5656
Practice Address - Street 1:26 W SALT MINE RD UNIT B
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7171
Practice Address - Country:US
Practice Address - Phone:928-567-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance