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General NPI Number Information
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NPI Number | 1700883113
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Entity Type | Organization
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Legal Business Name | BEAVER DAM LITTLEFIELD FIRE DISTRICT
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 630 N HWY 91
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City | LITTLEFIELD
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State | AZ
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Zip | 86432-0579
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Country | US
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Telephone | 928-347-5114
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Fax | 928-347-5273
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Provider Business Mailing Address
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Address Line | PO BOX 4451
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City | CAMP VERDE
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State | AZ
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Zip | 86322-4451
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Country | US
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Telephone | 928-567-0403
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Fax | 928-567-6403
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Authorized Official
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Title or Position | CAPTAIN
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Name | DAMON JACKSON
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Credential |
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Telephone | 928-347-5114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 124
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License Number State | AZ
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