Provider Demographics
NPI:1215921812
Name:SUNSITES PEARCE FIRE DISTRICT
Entity type:Organization
Organization Name:SUNSITES PEARCE FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-826-3645
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:PEARCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85625-0507
Mailing Address - Country:US
Mailing Address - Phone:520-826-3645
Mailing Address - Fax:520-826-3586
Practice Address - Street 1:105 N TRACY ROAD
Practice Address - Street 2:
Practice Address - City:PEARCE
Practice Address - State:AZ
Practice Address - Zip Code:85625-0412
Practice Address - Country:US
Practice Address - Phone:520-826-3645
Practice Address - Fax:520-826-3586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071316Medicaid
AZ071316001OtherAZ PHY IPA
AZ8100606OtherPACIFICARE SECURE HORIZON