Active NPI
Sacred Mountain Medical Services Inc
- Land Ambulance
- Tuba City, AZ
National Provider Identifier
1447288436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 127
- Legal business name
- SACRED MOUNTAIN MEDICAL SERVICES INC
- Practice address
- NP-39 Moenave Rd/Lolma St
Tuba City, AZ 86045 - Phone
- (928) 283-8243
- Fax
- (928) 283-8237
- NPI assigned
- Jun 29, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Danny Barney
- Title
- Owner
- Phone
- (928) 283-8243
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 127 | AZ | Primary |
Addresses
Primary practice location
NP-39 Moenave Rd/Lolma St
Tuba City, AZ 86045
Mailing address
PO Box 2290
Tuba City, AZ 86045-2290
Phone (928) 283-8243
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40953866 | Medicaid | NM | |
| XMTE06557 | Medicaid | CA | |
| 717077 | Medicaid | AZ | |
| 02876271 | Medicaid | MS | |
| AZ0152480 | Other | AZ | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040316000819 | AZ | Part B Supplier - Ambulance Service Supplier | 0840180766 | Practice locations: Kayenta, AZ; Tuba City, AZ |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1229904000000",
"number": "1447288436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2290",
"city": "TUBA CITY",
"state": "AZ",
"postal_code": "860452290",
"telephone_number": "928-283-8243",
"fax_number": "928-283-8237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "NP-39 MOENAVE RD/LOLMA ST",
"city": "TUBA CITY",
"state": "AZ",
"postal_code": "86045",
"telephone_number": "928-283-8243",
"fax_number": "928-283-8237"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SACRED MOUNTAIN MEDICAL SERVICES INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-29",
"last_updated": "2008-12-22",
"status": "A",
"authorized_official_last_name": "BARNEY",
"authorized_official_first_name": "DANNY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "928-283-8243"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "AZ",
"license": "127",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40953866",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "XMTE06557",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "717077",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02876271",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "AZ0152480",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tuba City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.