=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720205537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. TAMMANY PARISH FIRE PROTECTION DISTRICT NO 4
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2007
-----------------------------------------------------
Last Update Date | 10/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 709 GIROD STREET
-----------------------------------------------------
City | MANDEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-626-8671
-----------------------------------------------------
Fax | 985-626-8082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 709 GIROD STREET
-----------------------------------------------------
City | MANDEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-626-8671
-----------------------------------------------------
Fax | 985-626-8082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OF EMS
-----------------------------------------------------
Name | KEN SALZER
-----------------------------------------------------
Credential | PARAMEDIC / RN
-----------------------------------------------------
Telephone | 985-624-6555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 9110059
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------