Provider Demographics
NPI:1497836977
Name:EAST FORK FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:EAST FORK FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-782-9096
Mailing Address - Street 1:1694 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4405
Mailing Address - Country:US
Mailing Address - Phone:775-782-9044
Mailing Address - Fax:775-782-9043
Practice Address - Street 1:1694 COUNTY RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4405
Practice Address - Country:US
Practice Address - Phone:775-782-9044
Practice Address - Fax:775-782-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV04-130 & 04-4123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVUSA029990OtherMEDI-CAL
NV003203001Medicaid
NV003203001Medicaid
NVUSA029990OtherMEDI-CAL