Provider Demographics
NPI:1194124206
Name:FIRE PREVENTION DIST NO 12 PARISH OF ST. TAMMANY
Entity type:Organization
Organization Name:FIRE PREVENTION DIST NO 12 PARISH OF ST. TAMMANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-892-5161
Mailing Address - Street 1:19375 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8728
Mailing Address - Country:US
Mailing Address - Phone:985-892-5161
Mailing Address - Fax:985-249-5734
Practice Address - Street 1:19375 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8728
Practice Address - Country:US
Practice Address - Phone:985-892-5161
Practice Address - Fax:985-249-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22037820703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport