MEDICARE: CITY OF CALEXICO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	590086255	OTHER	CA	RRB

General Provider Information

NPI Number	:	1265437701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CALEXICO

Provider Business Mailing Address
First Line	:	608 HEBER AVE
Second Line	:
City	:	CALEXICO
State	:	CA
Zip	:	92231-2840
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 HEBER AVE
Second Line	:
City	:	CALEXICO
State	:	CA
Zip	:	92231-2840
Country	:	US
Telephone Number	:	760-768-2130
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	PETER F MERCADO
Credential	:
Telephone Number	:	760-768-2130

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/11/2013

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Directions to “CITY OF CALEXICO ” Practice Location

Language	Start Address	Practice Location

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