Healthcare Provider Details

I. General information

NPI: 1497836977
Provider Name (Legal Business Name): EAST FORK FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1694 COUNTY RD
MINDEN NV
89423-4405
US

IV. Provider business mailing address

1694 COUNTY RD
MINDEN NV
89423-4405
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-9044
  • Fax: 775-782-9043
Mailing address:
  • Phone: 775-782-9044
  • Fax: 775-782-9043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number04-130 & 04-412
License Number StateNV

VIII. Authorized Official

Name: MR. DAVID FOGERSON
Title or Position: DEPUTY FIRE CHIEF
Credential:
Phone: 775-782-9096