Provider Demographics
NPI:1194101808
Name:TIMBER MESA FIRE AND MEDICAL DISTRICT
Entity type:Organization
Organization Name:TIMBER MESA FIRE AND MEDICAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-5100
Mailing Address - Street 1:3561 E DEUCE OF CLUBS
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-5268
Mailing Address - Country:US
Mailing Address - Phone:928-537-5100
Mailing Address - Fax:928-368-5643
Practice Address - Street 1:2922 W WHITE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-6152
Practice Address - Country:US
Practice Address - Phone:928-537-5100
Practice Address - Fax:928-368-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ093135Medicaid
Z182789Medicare UPIN