Provider Demographics
NPI:1134334329
Name:KIRKWOOD FIRE DEPARTMENT
Entity type:Organization
Organization Name:KIRKWOOD FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:TABACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-258-2203
Mailing Address - Street 1:PO BOX 269110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-9110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 LOOP RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:CA
Practice Address - Zip Code:95646
Practice Address - Country:US
Practice Address - Phone:209-258-2203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance