Healthcare Provider Details

I. General information

NPI: 1982923413
Provider Name (Legal Business Name): HIGH COUNTRY FIRE RESCUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7052 N PINON PINE ST
WILLIAMS AZ
86046-8826
US

IV. Provider business mailing address

7052 N PINON PINE ST
WILLIAMS AZ
86046-8826
US

V. Phone/Fax

Practice location:
  • Phone: 928-635-9988
  • Fax:
Mailing address:
  • Phone: 928-635-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number79393
License Number StateAZ

VIII. Authorized Official

Name: MR. ROBERT L. TROTTER
Title or Position: EMS CAPTAIN
Credential: LPN, EMT-B
Phone: 928-635-4319