Provider Demographics
NPI:1750825790
Name:SOUTHEAST WELD FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:SOUTHEAST WELD FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-732-1028
Mailing Address - Street 1:95 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:KEENESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80643-9036
Mailing Address - Country:US
Mailing Address - Phone:303-732-4203
Mailing Address - Fax:
Practice Address - Street 1:65 E. GANDY AVE
Practice Address - Street 2:
Practice Address - City:KEENESBURG
Practice Address - State:CO
Practice Address - Zip Code:80643
Practice Address - Country:US
Practice Address - Phone:303-732-4203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO567370Medicare PIN