MEDICARE: CITY OF SAN LUIS ARIZONA

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	142	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	142	OTHER	AZ	CERTIFICATE OF NECESSITY

General Provider Information

NPI Number	:	1811360365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF SAN LUIS ARIZONA

Provider Business Mailing Address
First Line	:	PO BOX 7740
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85349-6816
Country	:	US
Telephone Number	:	928-341-8542
Fax Number	:	928-341-8549

Provider Business Practice Location Address
First Line	:	1165 NORTH MCCAIN AVENUE
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85349-0445
Country	:	US
Telephone Number	:	928-341-8550
Fax Number	:	928-627-1426

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MRS. MONICA CASTRO
Credential	:
Telephone Number	:	928-341-8542

Provider Enumeration Date	:	11/05/2015
Last Update Date	:	09/05/2023

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Directions to “CITY OF SAN LUIS ARIZONA ” Practice Location

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