MEDICARE: CITY OF NOGALES

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	3416L0300X	Land Ambulance

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	:	1073510699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF NOGALES

Provider Business Mailing Address
First Line	:	777 N GRAND AVE
Second Line	:
City	:	NOGALES
State	:	AZ
Zip	:	85621-2262
Country	:	US
Telephone Number	:	520-285-5647
Fax Number	:	520-287-2230

Provider Business Practice Location Address
First Line	:	777 N GRAND AVE
Second Line	:
City	:	NOGALES
State	:	AZ
Zip	:	85621-2262
Country	:	US
Telephone Number	:	520-285-5647
Fax Number	:	520-287-2230

Authorized Official
Title or Position	:	AMBULANCE BILLING SPECIALIST
Name	:	MS. PATRICIA EDITH MARES
Credential	:
Telephone Number	:	520-285-5647

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	08/22/2020

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Directions to “CITY OF NOGALES ” Practice Location

Language	Start Address	Practice Location

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