Healthcare Provider Details

I. General information

NPI: 1619914033
Provider Name (Legal Business Name): CITY OF DOUGLAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E 10TH ST
DOUGLAS AZ
85607-2308
US

IV. Provider business mailing address

425 10TH STREET
DOUGLAS AZ
85607-2308
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-2481
  • Fax: 520-364-5261
Mailing address:
  • Phone: 520-364-2481
  • Fax: 520-364-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS 2515
License Number StateAZ

VIII. Authorized Official

Name: MR. LUIS PEDROZA
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 520-419-7319