MEDICARE: IMPERIAL BEACH FIRE DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance

General Provider Information

NPI Number	:	1396802377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL BEACH FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	PO BOX 249
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-9349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	865 IMPERIAL BEACH BLVD
Second Line	:
City	:	IMPERIAL BEACH
State	:	CA
Zip	:	91932-2702
Country	:	US
Telephone Number	:	619-423-8223
Fax Number	:

Authorized Official
Title or Position	:	DEPUTY CHIEF
Name	:	PAUL SMITH
Credential	:
Telephone Number	:	619-423-8223

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	10/26/2007

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Directions to “IMPERIAL BEACH FIRE DEPARTMENT ” Practice Location

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