Provider Demographics
NPI:1588616445
Name:ST PAUL RURAL FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:ST PAUL RURAL FIRE PROTECTION DISTRICT
Other - Org Name:ST PAUL RURAL FIRE PROTECTION DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-932-5135
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:OR
Mailing Address - Zip Code:97137-0001
Mailing Address - Country:US
Mailing Address - Phone:503-633-4602
Mailing Address - Fax:503-633-4601
Practice Address - Street 1:4233 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:OR
Practice Address - Zip Code:97137-0001
Practice Address - Country:US
Practice Address - Phone:503-633-4602
Practice Address - Fax:503-633-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2408-063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165792Medicaid
067896000OtherBLUE CROSS/BLUE SHIELD
OR165792Medicaid