Provider Demographics
NPI:1720205537
Name:ST. TAMMANY PARISH FIRE PROTECTION DISTRICT NO 4
Entity Type:Organization
Organization Name:ST. TAMMANY PARISH FIRE PROTECTION DISTRICT NO 4
Other - Org Name:ST. TAMMANY FIRE DISTRICT 4
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OF EMS
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALZER
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC / RN
Authorized Official - Phone:985-624-6555
Mailing Address - Street 1:709 GIROD STREET
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448
Mailing Address - Country:US
Mailing Address - Phone:985-626-8671
Mailing Address - Fax:985-626-8082
Practice Address - Street 1:709 GIROD STREET
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448
Practice Address - Country:US
Practice Address - Phone:985-626-8671
Practice Address - Fax:985-626-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
LA91100593416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1995258Medicaid
LA1995258Medicaid