Heber-Overgaard Fire District
Organization Active NPI Land Ambulance · Overgaard, AZ
NPI 1770566705 · NPPES record last updated Apr 10, 2020
Key facts
- NPI
- 1770566705
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- HEBER-OVERGAARD FIRE DISTRICT
- Practice address
- 2061 Lumber Valley Rd
Overgaard, AZ 85933 - Phone
- (928) 535-4346
- Fax
- (928) 535-3175
- NPI assigned
- Nov 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. William D McCluskey
- Title
- Fire Chief
- Phone
- (928) 535-4346
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2195750 | Heber-Overgaard Fire District | Certificate of waiver | Oct 12, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100517000461 | AZ | Part B Supplier - Ambulance Service Supplier | 0749318475 | Practice locations: Overgaard, AZ |
| O20201216001567 | AZ | Part B Supplier - Mass Immunization (Roster Biller Only) | 0749318475 | Practice locations: Overgaard, AZ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
2061 Lumber Valley Rd
Overgaard, AZ 85933
Mailing address
PO Box 1010
Overgaard, AZ 85933-1010
Phone (928) 535-4346
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 351081 | Medicaid | AZ |
Other providers in Overgaard, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.