Active NPI
Hualapai Tribe
Doing business as Peach Springs EMS Rescue
- Land Ambulance
- Peach Springs, AZ
National Provider Identifier
1740497874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- HUALAPAI TRIBE
- Doing business as
- Peach Springs EMS Rescue
- Practice address
- 921 Hualapai Way
Peach Springs, AZ 86434 - Phone
- (928) 769-2656
- Fax
- (928) 769-2315
- NPI assigned
- May 17, 2007
- Last updated
- Jul 7, 2008
- 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
- Deedra Jean Taylor
- Title
- Program Manager
- Phone
- (928) 769-2656
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | NU | Primary |
Addresses
Primary practice location
921 Hualapai Way
Peach Springs, AZ 86434
Mailing address
PO Box 542
Peach Springs, AZ 86434-0542
Phone (928) 769-2656
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 146523 | Medicaid | AZ |
Other names 1
- Peach Springs EMS Rescue
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120912000864 | AZ | Part B Supplier - Ambulance Service Supplier | 9638327828 | Practice locations: Peach Springs, AZ |
National Provider Directory
National Provider Directory- Tax ID family
- Hualapai Health Department
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Peach Springs, AZ
- NPI 1568636116
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1215388800000",
"number": "1740497874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 542",
"city": "PEACH SPRINGS",
"state": "AZ",
"postal_code": "864340542",
"telephone_number": "928-769-2656",
"fax_number": "928-769-2315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "921 HUALAPAI WAY",
"city": "PEACH SPRINGS",
"state": "AZ",
"postal_code": "86434",
"telephone_number": "928-769-2656",
"fax_number": "928-769-2315"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HUALAPAI TRIBE",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-17",
"last_updated": "2008-07-07",
"status": "A",
"authorized_official_last_name": "TAYLOR",
"authorized_official_first_name": "DEEDRA",
"authorized_official_middle_name": "JEAN",
"authorized_official_title_or_position": "PROGRAM MANAGER",
"authorized_official_telephone_number": "928-769-2656"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "146523",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Peach Springs EMS Rescue",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Peach Springs, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.