Healthcare Provider Details

I. General information

NPI: 1386638930
Provider Name (Legal Business Name): CITY OF BISBEE AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 ARIZONA ST
BISBEE AZ
85603-1800
US

IV. Provider business mailing address

118 ARIZONA ST
BISBEE AZ
85603-1800
US

V. Phone/Fax

Practice location:
  • Phone: 520-378-3276
  • Fax: 520-378-0227
Mailing address:
  • Phone: 520-378-3276
  • Fax: 520-378-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3416L0300X
License Number StateAZ

VIII. Authorized Official

Name: DAVINA CASTILLO
Title or Position: AMBULANCE BILLING TECH
Credential:
Phone: 520-378-3276