MEDICARE: BASALT & RURAL 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		CO
2	3416L0300X	Land Ambulance	007-2011,008-2011,00	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790788305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASALT & RURAL FIRE PROTECTION DISTRICT

Provider Business Mailing Address
First Line	:	1089 JW DRIVE
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-9587
Country	:	US
Telephone Number	:	970-704-0675
Fax Number	:	970-704-0625

Provider Business Practice Location Address
First Line	:	1089 JW DRIVE
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-9587
Country	:	US
Telephone Number	:	970-704-0675
Fax Number	:	970-704-0625

Authorized Official
Title or Position	:	FINANCE CONTROLLER
Name	:	JENNIFER C. LEMKE
Credential	:
Telephone Number	:	970-704-0675

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/14/2011

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Directions to “BASALT & RURAL FIRE PROTECTION DISTRICT ” Practice Location

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