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General NPI Number Information
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NPI Number | 1184070112
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Entity Type | Organization
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Legal Business Name | CHILOQUIN - AGENCY LAKE RURAL FIRE PROTECTION DISTRICT
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 127 S 1ST AVE
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City | CHILOQUIN
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State | OR
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Zip | 97624-9738
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Country | US
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Telephone | 541-783-3860
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Fax | 541-783-3697
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Provider Business Mailing Address
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Address Line | PO BOX 437 127 S FIRST AVE
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City | CHILOQUIN
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State | OR
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Zip | 97624-0437
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Country | US
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Telephone | 541-783-3860
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Fax | 541-783-3697
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Authorized Official
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Title or Position | FIRE CHIEF
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Name | CHARLES MICHAEL COOK
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Credential |
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Telephone | 541-783-3860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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