MEDICARE: SOUTHWEST AMBULANCE OF CASA GRANDE

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
2	3416L0300X	Land Ambulance	85	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	:	1538116652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST AMBULANCE OF CASA GRANDE

Provider Business Mailing Address
First Line	:	PO BOX 847102
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7102
Country	:	US
Telephone Number	:	800-913-9106
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 W 2ND ST STE B
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-4415
Country	:	US
Telephone Number	:	520-876-0168
Fax Number	:

Authorized Official
Title or Position	:	EVP, CHIEF FINANCIAL OFFICER
Name	:	BRIAN SCOTT TIERNEY
Credential	:
Telephone Number	:	833-703-2294

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	02/19/2026

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Directions to “SOUTHWEST AMBULANCE OF CASA GRANDE ” Practice Location

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