Provider Demographics
NPI:1053343624
Name:CITY OF SIERRA VISTA
Entity type:Organization
Organization Name:CITY OF SIERRA VISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JR. ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-439-2162
Mailing Address - Street 1:1011 N CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-6334
Mailing Address - Country:US
Mailing Address - Phone:520-439-2162
Mailing Address - Fax:520-417-6932
Practice Address - Street 1:1011 N CORONADO DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6334
Practice Address - Country:US
Practice Address - Phone:520-439-2162
Practice Address - Fax:520-417-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070350Medicaid
MI01000810OtherHEALTH PLUS
KY189983600OtherUS DEPT OF LABOR
AZAZ0150630OtherBLUE CROSS BLUE SHIELD
AZ=========OtherALL OTHER INSURANCE
AZ070350Medicaid
GA756590411Medicare ID - Type UnspecifiedRR MEDICARE