=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689780413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH METRO FIRE RESCUE FIRE PROTECTION DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 11/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9195 E MINERAL AVE
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-3549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-989-2311
-----------------------------------------------------
Fax | 720-989-2110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9195 E MINERAL AVE
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-3549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-989-2311
-----------------------------------------------------
Fax | 720-989-2110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | DILLON MISKIMINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-989-2217
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------