Provider Demographics
NPI:1902947310
Name:VERDE VALLEY FIRE DISTRICT
Entity Type:Organization
Organization Name:VERDE VALLEY FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOERKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-634-2578
Mailing Address - Street 1:PO BOX 2153
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2153
Mailing Address - Country:US
Mailing Address - Phone:928-634-0665
Mailing Address - Fax:
Practice Address - Street 1:2700 E GODARD RD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-5140
Practice Address - Country:US
Practice Address - Phone:928-634-2578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106 EMS 2403341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070061Medicaid
AZZRMBBRMedicare PIN