Healthcare Provider Details

I. General information

NPI: 1982781571
Provider Name (Legal Business Name): CITY OF PHOENIX ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S 12TH ST
PHOENIX AZ
85034-2301
US

IV. Provider business mailing address

PO BOX 29102
PHOENIX AZ
85038-9102
US

V. Phone/Fax

Practice location:
  • Phone: 602-261-8414
  • Fax: 602-534-4827
Mailing address:
  • Phone: 602-261-8414
  • Fax: 602-534-4827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberEMS2836
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMS2836
License Number StateAZ

VIII. Authorized Official

Name: MRS. PAMELA WAYNE
Title or Position: MEDICAL BILLING SUPERVISOR
Credential:
Phone: 602-534-4627