Provider Demographics
NPI:1235121773
Name:BLACK BUTTE RANCH RURAL FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:BLACK BUTTE RANCH RURAL FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-595-2288
Mailing Address - Street 1:PMB 8190 PO BOX 8000
Mailing Address - Street 2:
Mailing Address - City:BLACK BUTTE RANCH
Mailing Address - State:OR
Mailing Address - Zip Code:97759
Mailing Address - Country:US
Mailing Address - Phone:541-595-2288
Mailing Address - Fax:541-595-6867
Practice Address - Street 1:13511 HAWKS BEARD
Practice Address - Street 2:
Practice Address - City:BLACK BUTTE RANCH
Practice Address - State:OR
Practice Address - Zip Code:97759
Practice Address - Country:US
Practice Address - Phone:541-595-2288
Practice Address - Fax:541-595-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0904-06146L00000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000RGBPTMedicare ID - Type Unspecified