South Lake County Fire Protection District

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

SOUTH LAKE COUNTY FIRE PROTECTION DISTRICT

Practice address

21095 Highway 175
Middletown, CA 95461-9527

Phone

(707) 987-3089

NPI assigned

Jul 26, 2005

Last updated

Dec 17, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Greg Bertelli

Title

Fire Chief

Phone

(707) 279-2125

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576540800000",
    "number": "1265432801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 269110",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958269110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21095 HIGHWAY 175",
            "city": "MIDDLETOWN",
            "state": "CA",
            "postal_code": "954619527",
            "telephone_number": "707-987-3089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE COUNTY FIRE PROTECTION DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "BERTELLI",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "707-279-2125"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRB",
            "identifier": "590004954",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ83591Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deidre Anne O'Malley, BSN RN LAC.
• Margaret Ellen Raintree, L.C.S.W.
• Stefan J Ripich, CNP
• Ryan Runyon, RAS, CSC,CAS
• Sheila Safarian, DDS
• Ian P. Van Zyl, DDS, MS

• Land Ambulance in Middletown, CA
• Providers in Middletown, CA by specialty
• Land Ambulance in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; 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.

Verify at the official NPI Registry.