Provider Demographics
NPI:1538120688
Name:CROOK COUNTY FIRE AND RESCUE
Entity Type:Organization
Organization Name:CROOK COUNTY FIRE AND RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHEIF
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-447-5011
Mailing Address - Street 1:500 NE BELKNAP ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1932
Mailing Address - Country:US
Mailing Address - Phone:541-447-5011
Mailing Address - Fax:541-447-2705
Practice Address - Street 1:500 NE BELKNAP ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1932
Practice Address - Country:US
Practice Address - Phone:541-447-5011
Practice Address - Fax:541-447-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0701-043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR029041Medicaid
ORR119305Medicare ID - Type UnspecifiedPROVIDER NUMBER