Provider Demographics
NPI:1053495069
Name:KLAMATH COUNTY FIRE DIST NO 4
Entity Type:Organization
Organization Name:KLAMATH COUNTY FIRE DIST NO 4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL LEGAL REP
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:541-882-6984
Mailing Address - Street 1:2261 SOUTH 6TH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-882-6984
Mailing Address - Fax:541-884-7585
Practice Address - Street 1:4041 BALSAM DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-5406
Practice Address - Country:US
Practice Address - Phone:541-884-1670
Practice Address - Fax:541-850-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORE219377341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR031174Medicaid
ORR0000RGCFMMedicare PIN