MEDICARE: EAST FORK FIRE PROTECTION DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	04-130 & 04-412	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	USA029990	OTHER	NV	MEDI-CAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497836977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST FORK FIRE PROTECTION DISTRICT

Provider Business Mailing Address
First Line	:	1694 COUNTY RD
Second Line	:
City	:	MINDEN
State	:	NV
Zip	:	89423-4405
Country	:	US
Telephone Number	:	775-782-9044
Fax Number	:	775-782-9043

Provider Business Practice Location Address
First Line	:	1694 COUNTY RD
Second Line	:
City	:	MINDEN
State	:	NV
Zip	:	89423-4405
Country	:	US
Telephone Number	:	775-782-9044
Fax Number	:	775-782-9043

Authorized Official
Title or Position	:	DEPUTY FIRE CHIEF
Name	:	MR. DAVID FOGERSON
Credential	:
Telephone Number	:	775-782-9096

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	05/27/2016

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Directions to “EAST FORK FIRE PROTECTION DISTRICT ” Practice Location

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