Montezuma Rimrock Fire District

Primary specialty

AmbulanceTaxonomy code 341600000X

License

3 Issued in AZ

Legal business name

MONTEZUMA RIMROCK FIRE DISTRICT

Practice address

3240 E Beaver Creek Rd
Rimrock, AZ 86335-5127

Phone

(928) 567-7428

Fax

(928) 567-4743

NPI assigned

Aug 30, 2005

Last updated

Oct 15, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Van Dyke

Title

Fire Chief

Phone

(928) 567-7428

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1073506416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3240 E BEAVER CREEK RD",
            "city": "RIMROCK",
            "state": "AZ",
            "postal_code": "863355127",
            "telephone_number": "928-567-7428",
            "fax_number": "928-567-4743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 E BEAVER CREEK RD",
            "city": "RIMROCK",
            "state": "AZ",
            "postal_code": "863355127",
            "telephone_number": "928-567-7428",
            "fax_number": "928-567-4743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTEZUMA RIMROCK FIRE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-30",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "VAN DYKE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "928-567-7428"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "AZ",
            "license": "3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378613",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Gonchar, LASAC
• Clay Conrad Khin
• Lake Montezuma RTC, LLC (Sedona Sky Academy)
• Katie McAndrew, SLPA
• Ingvild Mikkelborg, MA
• Timothy Mullins, MA
• Shelbi Lynn Labat Petrosius, LPC
• Nancy Ann Pfefferkorn, OTR/L
• Rapha Wellness LLC
• Sedona Sky Opco LLC (Sedona Sky Academy)

• Ambulance in Rimrock, AZ
• Providers in Rimrock, AZ by specialty
• Ambulance in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.