Provider Demographics
NPI:1730194572
Name:BEAVER FIRE SERVICE DISTRICT 1
Entity type:Organization
Organization Name:BEAVER FIRE SERVICE DISTRICT 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:YARDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-438-7151
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-0549
Mailing Address - Country:US
Mailing Address - Phone:435-438-7151
Mailing Address - Fax:435-438-7166
Practice Address - Street 1:1090 N MAIN
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-0549
Practice Address - Country:US
Practice Address - Phone:435-438-7151
Practice Address - Fax:435-438-7166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAVER FIRE SERVICE DISTRICT 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0101L341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT990002018001Medicaid