MEDICARE: MOHAVE VALLEY FIRE DEPARTMENT

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	38	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0052407	OTHER	CA	KAISER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	AZ 0151130	OTHER	AZ	BC/BS OF ARIZONA
7	USAAMB000	OTHER	CA	BLUE SHIELD OF CALIFORNIA
8	AM FS 0398640	OTHER	CA	BLUE CROSS OF CALIFORNIA
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083664999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAVE VALLEY FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	1451 WILLOW DR
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-8542
Country	:	US
Telephone Number	:	928-768-9113
Fax Number	:	928-768-9119

Provider Business Practice Location Address
First Line	:	1451 WILLOW DR
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-8542
Country	:	US
Telephone Number	:	928-768-9113
Fax Number	:	928-768-9119

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MR. MEL S SORENSEN
Credential	:
Telephone Number	:	928-768-9113

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	02/02/2012

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Directions to “MOHAVE VALLEY FIRE DEPARTMENT ” Practice Location

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