Healthcare Provider Details

I. General information

NPI: 1649273004
Provider Name (Legal Business Name): KEIZER RURAL FIRE PROTECTION DIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 CHEMAWA RD NE
KEIZER OR
97303-4436
US

IV. Provider business mailing address

661 CHEMAWA RD NE
KEIZER OR
97303-4436
US

V. Phone/Fax

Practice location:
  • Phone: 503-390-9111
  • Fax: 503-390-8299
Mailing address:
  • Phone: 503-390-9111
  • Fax: 503-390-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number241306
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier139365
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier590011519
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerRAILROAD MEDICARE PIN

VIII. Authorized Official

Name: MR. JEFF S COWAN
Title or Position: FIRE CHIEF
Credential:
Phone: 503-390-9111