Provider Demographics
NPI:1003419490
Name:SOUTHERN JACKSON COUNTY FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:SOUTHERN JACKSON COUNTY FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:LARGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-535-2320
Mailing Address - Street 1:101 LOTAWANA DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE LOTAWANA
Mailing Address - State:MO
Mailing Address - Zip Code:64086
Mailing Address - Country:US
Mailing Address - Phone:816-535-2320
Mailing Address - Fax:816-578-5815
Practice Address - Street 1:101 LOTAWANA DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE LOTAWANA
Practice Address - State:MO
Practice Address - Zip Code:64086
Practice Address - Country:US
Practice Address - Phone:816-535-2320
Practice Address - Fax:816-578-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty