Healthcare Provider Details

I. General information

NPI: 1669486593
Provider Name (Legal Business Name): COLORADO CITY FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SOUTH PIONEER ST.
COLORADO CITY AZ
86021-1588
US

IV. Provider business mailing address

40 SOUTH PIONEER STREET PO BOX 1588
COLORADO CITY AZ
86021-1588
US

V. Phone/Fax

Practice location:
  • Phone: 928-875-2400
  • Fax: 928-875-2056
Mailing address:
  • Phone: 928-875-2400
  • Fax: 928-875-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number22
License Number StateAZ

VIII. Authorized Official

Name: MR. JAKE BARLOW
Title or Position: CHIEF
Credential:
Phone: 928-875-2400