MEDICARE: CITY OF VACAVILLE

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	590480422	OTHER		RRB
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679572176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF VACAVILLE

Provider Business Mailing Address
First Line	:	650 MERCHANT ST
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-6992
Country	:	US
Telephone Number	:	707-449-5462
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 MERCHANT ST
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-6908
Country	:	US
Telephone Number	:	707-449-5452
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	KRISTIAN CONCEPCION
Credential	:
Telephone Number	:	707-449-5462

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	03/29/2022

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Directions to “CITY OF VACAVILLE ” Practice Location

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