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General NPI Number Information
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NPI Number | 1801441613
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Entity Type | Organization
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Legal Business Name | GRAND LAKE FIRE PROTECTION DISTRICT
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 201 WEST PORTAL ROAD
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City | GRAND LAKE
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State | CO
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Zip | 80447
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Country | US
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Telephone | 970-627-8428
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1408
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City | GRAND LAKE
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State | CO
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Zip | 80447-1408
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Country | US
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Telephone | 970-627-8428
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Fax |
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Authorized Official
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Title or Position | ASSISTANT FIRE CHIEF
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Name | SETH ST. GERMAIN
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Credential | NREMT / COLORADO EMT
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Telephone | 970-627-8428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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