Healthcare Provider Details

I. General information

NPI: 1417961244
Provider Name (Legal Business Name): CITY OF BISBEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 HWY 92
BISBEE AZ
85603
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-4110
  • Fax: 520-432-2594
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GEORGE ANTHONY CASTILLO
Title or Position: DIRECTOR
Credential:
Phone: 520-432-4110