MEDICARE: BULLHEAD CITY FIRE DEPARTMENT

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	EMS 2767	AZ

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AZ0151570	OTHER	AZ	BLUE CROSS/BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	AZBCF-SWT	OTHER	AZ	OTHER INSURANCE PROVIDERS

General Provider Information

NPI Number	:	1710071410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BULLHEAD CITY FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	1260 HANCOCK RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5906
Country	:	US
Telephone Number	:	928-758-3971
Fax Number	:	928-763-3297

Provider Business Practice Location Address
First Line	:	1260 HANCOCK RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5906
Country	:	US
Telephone Number	:	928-758-3971
Fax Number	:	928-763-3297

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	RICK SOUTHEY
Credential	:	CHIEF
Telephone Number	:	928-758-3971

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/23/2009

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Directions to “BULLHEAD CITY FIRE DEPARTMENT ” Practice Location

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