Provider Demographics
NPI:1528096278
Name:LONE JACK COMMUNITY FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:LONE JACK COMMUNITY FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-512-2019
Mailing Address - Street 1:107 WEST MAIN STREET
Mailing Address - Street 2:PO BOX 50
Mailing Address - City:LONE JACK
Mailing Address - State:MO
Mailing Address - Zip Code:64070-0050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LONE JACK
Practice Address - State:MO
Practice Address - Zip Code:64070-9761
Practice Address - Country:US
Practice Address - Phone:816-512-2019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0953033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9004253Medicare PIN