1053385286 NPI number — PIERCE COUNTY FPD #15

Table of content: (NPI 1053385286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053385286 NPI number — PIERCE COUNTY FPD #15

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIERCE COUNTY FPD #15
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:
SOUTH PIERCE FIRE & RESCUE
Provider Other Organization Name Type Code:
3
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:
1053385286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-613-1627
Provider Business Mailing Address Fax Number:
360-698-4968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5403 340TH ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATONVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98328-9633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-847-4333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAFE
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
253-847-4333

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  27D15 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8934203 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0155701 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9051574 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5750PI . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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