Provider Demographics
NPI:1477712214
Name:PARADISE VALLEY FIRE SERVICE AREA
Entity Type:Organization
Organization Name:PARADISE VALLEY FIRE SERVICE AREA
Other - Org Name:PARADISE VALLEY FIRE EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN OF BOARD OF TRUSTEES
Authorized Official - Prefix:
Authorized Official - First Name:BERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-333-4357
Mailing Address - Street 1:PO BOX 1634
Mailing Address - Street 2:
Mailing Address - City:EMIGRANT
Mailing Address - State:MT
Mailing Address - Zip Code:59027-1634
Mailing Address - Country:US
Mailing Address - Phone:406-333-4357
Mailing Address - Fax:406-333-4118
Practice Address - Street 1:1140 EAST RIVER ROAD
Practice Address - Street 2:
Practice Address - City:PRAY
Practice Address - State:MT
Practice Address - Zip Code:59065
Practice Address - Country:US
Practice Address - Phone:406-333-4357
Practice Address - Fax:406-333-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4653416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport