Provider Demographics
NPI:1861962367
Name:COPPER CANYON FIRE & MEDICAL DISTRICT
Entity type:Organization
Organization Name:COPPER CANYON FIRE & MEDICAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-567-9401
Mailing Address - Street 1:PO BOX 1543
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-1543
Mailing Address - Country:US
Mailing Address - Phone:928-567-9401
Mailing Address - Fax:928-567-3919
Practice Address - Street 1:494 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7256
Practice Address - Country:US
Practice Address - Phone:928-567-9401
Practice Address - Fax:928-567-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance