Healthcare Provider Details

I. General information

NPI: 1689611238
Provider Name (Legal Business Name): CITY OF ST.JOHNS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S. WASHINGTON
ST JOHNS AZ
85936
US

IV. Provider business mailing address

PO BOX 455
ST JOHNS AZ
85936-0455
US

V. Phone/Fax

Practice location:
  • Phone: 928-337-3070
  • Fax: 928-337-4786
Mailing address:
  • Phone: 928-337-4517
  • Fax: 928-337-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: AMY M BIGELOW
Title or Position: FINANCE DIRECTOR / CITY CLERK
Credential:
Phone: 928-337-4517