Healthcare Provider Details

I. General information

NPI: 1891152567
Provider Name (Legal Business Name): WHITE MOUNTAIN APACHE TRIBE FIRE AND RESCUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S. CHIEF AVE
WHITERIVER AZ
85941
US

IV. Provider business mailing address

612 S. CHIEF AVE
WHITERIVER AZ
85941
US

V. Phone/Fax

Practice location:
  • Phone: 928-368-6799
  • Fax: 928-368-8776
Mailing address:
  • Phone: 928-368-6799
  • Fax: 928-368-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBYNN LONGENBAUGH
Title or Position: A/R MANAGER
Credential:
Phone: 928-368-6799