MEDICARE: MONTEZUMA RIMROCK FIRE DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	3	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073506416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTEZUMA RIMROCK FIRE DISTRICT

Provider Business Mailing Address
First Line	:	3240 E BEAVER CREEK RD
Second Line	:
City	:	RIMROCK
State	:	AZ
Zip	:	86335-5127
Country	:	US
Telephone Number	:	928-567-7428
Fax Number	:	928-567-4743

Provider Business Practice Location Address
First Line	:	3240 E BEAVER CREEK RD
Second Line	:
City	:	RIMROCK
State	:	AZ
Zip	:	86335-5127
Country	:	US
Telephone Number	:	928-567-7428
Fax Number	:	928-567-4743

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MICHAEL VAN DYKE
Credential	:
Telephone Number	:	928-567-7428

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	10/15/2007

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Directions to “MONTEZUMA RIMROCK FIRE DISTRICT ” Practice Location

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