MEDICARE: COLORADO CITY 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	3416L0300X	Land Ambulance	22	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	:	1669486593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO CITY FIRE DISTRICT

Provider Business Mailing Address
First Line	:	40 SOUTH PIONEER STREET
Second Line	:	PO BOX 1588
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-1588
Country	:	US
Telephone Number	:	928-875-2400
Fax Number	:	928-875-2056

Provider Business Practice Location Address
First Line	:	40 SOUTH PIONEER ST.
Second Line	:
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-1588
Country	:	US
Telephone Number	:	928-875-2400
Fax Number	:	928-875-2056

Authorized Official
Title or Position	:	CHIEF
Name	:	MR. JAKE BARLOW
Credential	:
Telephone Number	:	928-875-2400

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	12/04/2012

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Directions to “COLORADO CITY FIRE DISTRICT ” Practice Location

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