MEDICARE: SOUTH PLACER FIRE 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

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	:	1922008481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH PLACER FIRE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 269110
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-9110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 EUREKA RD
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6531
Country	:	US
Telephone Number	:	916-791-7059
Fax Number	:

Authorized Official
Title or Position	:	EMS CAPTAIN
Name	:	JASON BROOKS
Credential	:
Telephone Number	:	916-791-7059

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	10/18/2007

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Directions to “SOUTH PLACER FIRE DISTRICT ” Practice Location

Language	Start Address	Practice Location

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