Provider Demographics
NPI:1144406570
Name:LA VETA FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:LA VETA FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-742-6777
Mailing Address - Street 1:P.O. BOX 44
Mailing Address - Street 2:
Mailing Address - City:LA VETA
Mailing Address - State:CO
Mailing Address - Zip Code:81055-0044
Mailing Address - Country:US
Mailing Address - Phone:719-742-3656
Mailing Address - Fax:719-742-3656
Practice Address - Street 1:111 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LA VETA
Practice Address - State:CO
Practice Address - Zip Code:81055-0044
Practice Address - Country:US
Practice Address - Phone:719-742-3656
Practice Address - Fax:719-742-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50881736Medicaid
P00780441Medicare PIN
COCOB4194Medicare PIN