Puerco Valley Ambulance

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

116 Issued in AZ

Legal business name

PUERCO VALLEY AMBULANCE

Practice address

105 S Hwy 191
Sanders, AZ 86512

Phone

(928) 688-3616

Fax

(928) 688-2922

NPI assigned

Feb 1, 2006

Organization subpart

No

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

Authorized official

Name

Tami Wood

Title

Assistant Admin Chief

Phone

(928) 688-3616

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1922079458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39",
            "city": "SANDERS",
            "state": "AZ",
            "postal_code": "865120039",
            "telephone_number": "928-688-3616",
            "fax_number": "928-688-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S HWY 191",
            "city": "SANDERS",
            "state": "AZ",
            "postal_code": "86512",
            "telephone_number": "928-688-3616",
            "fax_number": "928-688-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUERCO VALLEY AMBULANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "ASSISTANT ADMIN CHIEF",
        "authorized_official_telephone_number": "928-688-3616"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "AZ",
            "license": "116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "070558",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "R3451",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shandina Manycows
• Marvin R Martine, LISAC
• Newlands Outpatient Treatment Center
• Northern Apache County Special Health Care District
• Northern Apache County Special Health Care District
• Deborah J Reeves, LISAC
• Sanders Unified School District
• Debbie Samantha Taylor-Hill, RN
• Steven Tsinijinni, LISAC

• All providers in Sanders, AZ
• Land Ambulance in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.