Provider Demographics
NPI:1386677425
Name:GRAND JUNCTION FIRE AND RESCUE UNIT INC
Entity Type:Organization
Organization Name:GRAND JUNCTION FIRE AND RESCUE UNIT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESCUE CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RENSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-738-2585
Mailing Address - Street 1:109 EAST MAIN
Mailing Address - Street 2:PO BOX 255
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:IA
Mailing Address - Zip Code:50107
Mailing Address - Country:US
Mailing Address - Phone:515-738-2585
Mailing Address - Fax:515-386-8098
Practice Address - Street 1:109 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:IA
Practice Address - Zip Code:50107
Practice Address - Country:US
Practice Address - Phone:515-738-2585
Practice Address - Fax:515-386-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23702003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11083OtherBLUE CROSS BLUE SHIELD
IA0485201Medicaid
IAI16853Medicare ID - Type Unspecified