Active NPI
South Fork Fire Protection District
- Land Ambulance
- South Fork, CO
National Provider Identifier
1205242872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 154
- Legal business name
- SOUTH FORK FIRE PROTECTION DISTRICT
- Practice address
- 0028 Mall Road
South Fork, CO 81154 - Phone
- (719) 873-1030
- Fax
- (719) 873-1030
- NPI assigned
- Jul 3, 2014
- Last updated
- Jan 26, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tyler Off
- Title
- Fire Chief
- Phone
- (719) 873-1030
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 154 | CO | Primary |
Addresses
Primary practice location
0028 Mall Road
South Fork, CO 81154
Mailing address
PO Box 579
South Fork, CO 81154-0579
Phone (719) 873-1030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150513000581 | CO | Part B Supplier - Ambulance Service Supplier | 7810217924 | Practice locations: South Fork, CO |
National Provider Directory
National Provider DirectoryLocations
28 Mall St
South Fork, CO 81154
Phone (719) 852-2362
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404345600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1422230400000",
"number": "1205242872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 579",
"city": "SOUTH FORK",
"state": "CO",
"postal_code": "811540579",
"telephone_number": "719-873-1030",
"fax_number": "719-873-0201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "0028 MALL ROAD",
"city": "SOUTH FORK",
"state": "CO",
"postal_code": "81154",
"telephone_number": "719-873-1030",
"fax_number": "719-873-1030"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTH FORK FIRE PROTECTION DISTRICT",
"organizational_subpart": "NO",
"enumeration_date": "2014-07-03",
"last_updated": "2015-01-26",
"status": "A",
"authorized_official_last_name": "OFF",
"authorized_official_first_name": "TYLER",
"authorized_official_title_or_position": "FIRE CHIEF",
"authorized_official_telephone_number": "719-873-1030"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "CO",
"license": "154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Fork, CO
- San Luis Valley Community Mental Health Center (San Luis Valley Behavioral Health Group)
- San Luis Valley Community Mental Health Center (San Luis Valley Behavioral Health Group)
- San Luis Valley Community Mental Health Center (San Luis Valley Behavioral Health Group)
- San Luis Valley Community Mental Health Center, Inc. (San Luis Valley Behavioral Health Group)
- South Fork Ambulance Association
- Valley Citizens' Foundation for Health Care Inc (Rio Grande Hospital Clinic at South Fork)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.