Provider Demographics
NPI:1538230016
Name:TOWN OF SUPERIOR
Entity type:Organization
Organization Name:TOWN OF SUPERIOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-689-5671
Mailing Address - Street 1:734 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85273-3409
Mailing Address - Country:US
Mailing Address - Phone:520-689-5671
Mailing Address - Fax:520-689-2470
Practice Address - Street 1:734 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:AZ
Practice Address - Zip Code:85273-3409
Practice Address - Country:US
Practice Address - Phone:520-689-5671
Practice Address - Fax:520-689-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ709628Medicaid
AZ709628Medicaid