1346386257 NPI number — PENN VALLEY FIRE PROTECTION DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346386257 NPI number — PENN VALLEY FIRE PROTECTION DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN VALLEY FIRE PROTECTION DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346386257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 180
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95946-0180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-432-2630
Provider Business Mailing Address Fax Number:
530-432-4561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10513 SPENCEVILLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-432-2630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
530-432-2630

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MTE00062F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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