=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346464666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN INYO FIRE PROTECTION DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 07/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 TECOPA HOT SPRINGS RD
-----------------------------------------------------
City | TECOPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92389-0051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-852-4130
-----------------------------------------------------
Fax | 760-852-4130
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 51
-----------------------------------------------------
City | TECOPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92389-0051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-852-4130
-----------------------------------------------------
Fax | 760-852-4130
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD CHAIRPERSON
-----------------------------------------------------
Name | MS. ROBIN K FLINCHUM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-852-4941
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------