Provider Demographics
NPI:1801441613
Name:GRAND LAKE FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:GRAND LAKE FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT / COLORADO EMT
Authorized Official - Phone:970-627-8428
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:GRAND LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80447-1408
Mailing Address - Country:US
Mailing Address - Phone:970-627-8428
Mailing Address - Fax:
Practice Address - Street 1:201 WEST PORTAL ROAD
Practice Address - Street 2:
Practice Address - City:GRAND LAKE
Practice Address - State:CO
Practice Address - Zip Code:80447
Practice Address - Country:US
Practice Address - Phone:970-627-8428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty