Provider Demographics
NPI:1982781571
Name:CITY OF PHOENIX ARIZONA
Entity Type:Organization
Organization Name:CITY OF PHOENIX ARIZONA
Other - Org Name:CITY OF PHOENIX ETS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-534-4627
Mailing Address - Street 1:PO BOX 29102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9102
Mailing Address - Country:US
Mailing Address - Phone:602-261-8414
Mailing Address - Fax:602-534-4827
Practice Address - Street 1:150 S 12TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2301
Practice Address - Country:US
Practice Address - Phone:602-261-8414
Practice Address - Fax:602-534-4827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZEMS2836146L00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZB10858Medicaid
RR9786OtherRAILROAD MEDICARE
AZZ=========Medicare PIN