NPIMap

Organization Active NPI

White Mountain Apache Tribe

  • Land Ambulance
  • Whiteriver, AZ
National Provider Identifier
1760522155
Registry record updated Dec 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
Legal business name
WHITE MOUNTAIN APACHE TRIBE
Practice address
103 W. Rainbow
Whiteriver, AZ 85941-1210
Phone
(928) 338-3095
Fax
(928) 338-3097
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2013

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

Authorized official

Name
Ed Benally
Title
EMS Director
Phone
(928) 338-3095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X Primary

Addresses

Primary practice location

103 W. Rainbow
Whiteriver, AZ 85941-1210

Mailing address

PO Box 1210
Whiteriver, AZ 85941-1210
Phone (928) 338-3095

Other identifiers 1

IdentifierTypeStateIssuer
071184MedicaidAZ

Other names 1

  • White Mountain Apache Tribe EMS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040528000223 AZ Part B Supplier - Ambulance Service Supplier 6002897634 Practice locations: Whiteriver, AZ

National Provider Directory

National Provider Directory
Tax ID family
Rainbow Treatment Center White Mountain Apache Tribe5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386547200000",
    "number": "1760522155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1210",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "859411210",
            "telephone_number": "928-338-3095",
            "fax_number": "928-338-3097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W. RAINBOW",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "859411210",
            "telephone_number": "928-338-3095",
            "fax_number": "928-338-3097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE MOUNTAIN APACHE TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2013-12-09",
        "status": "A",
        "authorized_official_last_name": "BENALLY",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "EMS DIRECTOR",
        "authorized_official_telephone_number": "928-338-3095"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "071184",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Mountain Apache Tribe EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Whiteriver, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; 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.

Verify at the official NPI Registry.