Healthcare Provider Details

I. General information

NPI: 1770182552
Provider Name (Legal Business Name): PLATEAU VALLEY FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49084 KE 1/2 ROAD
MESA CO
81643-0210
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 970-785-2232
  • Fax:
Mailing address:
  • Phone: 402-572-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL ALLAN LOCKWOOD
Title or Position: CHIEF
Credential:
Phone: 970-268-5283