Healthcare Provider Details

I. General information

NPI: 1619933587
Provider Name (Legal Business Name): MAYER FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11975 S. HWY 69
MAYER AZ
86333-0340
US

IV. Provider business mailing address

PO BOX 340
MAYER AZ
86333-0340
US

V. Phone/Fax

Practice location:
  • Phone: 928-632-9534
  • Fax: 928-632-7463
Mailing address:
  • Phone: 928-632-9534
  • Fax: 928-632-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberCON # 117 / EMS 2900
License Number StateAZ

VIII. Authorized Official

Name: SUZANNE OWEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 928-632-9534