Provider Demographics
NPI:1063527737
Name:LANDS END FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:LANDS END FIRE PROTECTION DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KEMITT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-242-2975
Mailing Address - Street 1:P.O. BOX 250
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:81527
Mailing Address - Country:US
Mailing Address - Phone:970-242-2975
Mailing Address - Fax:970-242-2975
Practice Address - Street 1:34980 PRONGHORN DRIVE
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:CO
Practice Address - Zip Code:81527
Practice Address - Country:US
Practice Address - Phone:970-242-2975
Practice Address - Fax:970-242-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2005-203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72537597Medicaid
CO=========OtherBCBS
CO72537597Medicaid
804911Medicare PIN