NPIMap

Organization Active NPI

Sacred Mountain Medical Service

  • Land Ambulance
  • Tuba City, AZ
National Provider Identifier
1871739755
Registry record updated Dec 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
127 Issued in AZ
Legal business name
SACRED MOUNTAIN MEDICAL SERVICE
Practice address
100 Moenave Road
#39
Tuba City, AZ 86045
Phone
(928) 283-8243
Fax
(928) 283-8237
NPI assigned
Dec 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2008

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

Authorized official

Name
Mr. Danny Barney
Title
Ceo
Phone
(928) 283-8243

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 127 AZ Primary

Addresses

Primary practice location

100 Moenave Road
#39
Tuba City, AZ 86045

Mailing address

PO Box 2290
Tuba City, AZ 86045-2290
Phone (928) 283-8243

Other identifiers 6

IdentifierTypeStateIssuer
40953866MedicaidNM
XMTEO6557MedicaidCA
717077MedicaidAZ
AZ0152480OtherAZBLUE CROSS BLUE SHIELD
02876271MedicaidMS
830384848001MedicaidUT

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1230249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230249600000",
    "number": "1871739755",
    "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": "100 MOENAVE ROAD",
            "address_2": "#39",
            "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 SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-26",
        "last_updated": "2008-12-26",
        "status": "A",
        "authorized_official_last_name": "BARNEY",
        "authorized_official_first_name": "DANNY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-283-8243",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "XMTEO6557",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "717077",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0152480",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02876271",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "830384848001",
            "state": "UT"
        }
    ],
    "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 26, 2008; 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.