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General NPI Number Information
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NPI Number | 1871739755
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Entity Type | Organization
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Legal Business Name | SACRED MOUNTAIN MEDICAL SERVICE
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Dates
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Enumeration Date | 12/26/2008
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Last Update Date | 12/26/2008
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Provider Practice Location Address
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Address Line | 100 MOENAVE ROAD #39
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City | TUBA CITY
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State | AZ
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Zip | 86045
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Country | US
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Telephone | 928-283-8243
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Fax | 928-283-8237
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Provider Business Mailing Address
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Address Line | PO BOX 2290
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City | TUBA CITY
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State | AZ
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Zip | 86045-2290
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Country | US
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Telephone | 928-283-8243
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Fax | 928-283-8237
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Authorized Official
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Title or Position | CEO
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Name | MR. DANNY BARNEY
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Credential |
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Telephone | 928-283-8243
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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 | 127
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License Number State | AZ
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