Healthcare Provider Details

I. General information

NPI: 1205985298
Provider Name (Legal Business Name): PINETOP VOLUNTEER FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 S PINE LAKE RD
PINETOP AZ
85935-8064
US

IV. Provider business mailing address

1845 S PINE LAKE RD
PINETOP AZ
85935-8064
US

V. Phone/Fax

Practice location:
  • Phone: 928-367-2199
  • Fax:
Mailing address:
  • Phone: 928-367-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number96
License Number StateAZ

VIII. Authorized Official

Name: ROBYNN LEIGH LONGENBAUGH
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 928-368-6799