=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801425434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIMBER MESA FIRE AND MEDICAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2020
-----------------------------------------------------
Last Update Date | 04/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3561 E DEUCE OF CLUBS
-----------------------------------------------------
City | SHOW LOW
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85901-5329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-537-5100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3561 E DEUCE OF CLUBS
-----------------------------------------------------
City | SHOW LOW
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85901-5329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-537-5100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE CLERK
-----------------------------------------------------
Name | DEANNA DEE REED
-----------------------------------------------------
Credential | CAC
-----------------------------------------------------
Telephone | 928-531-5700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------