Provider Demographics
NPI:1073603528
Name:CRESCENT RURAL FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:CRESCENT RURAL FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-433-2466
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:GILCHRIST
Mailing Address - State:OR
Mailing Address - Zip Code:97737-0811
Mailing Address - Country:US
Mailing Address - Phone:541-433-2466
Mailing Address - Fax:541-433-2600
Practice Address - Street 1:150 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:GILCHRIST
Practice Address - State:OR
Practice Address - Zip Code:97737-3244
Practice Address - Country:US
Practice Address - Phone:541-433-2466
Practice Address - Fax:541-433-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1830341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR800382Medicaid
OR171017Medicaid
OR50220Medicaid
OR1073603528OtherMEDICARE
OR50220Medicaid