1083688287 NPI number — JEFFERSON COUNTY FIRE PROTECTION DISTRICT 1 JEFFERSON COUNTY

Table of content: (NPI 1083688287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083688287 NPI number — JEFFERSON COUNTY FIRE PROTECTION DISTRICT 1 JEFFERSON COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON COUNTY FIRE PROTECTION DISTRICT 1 JEFFERSON COUNTY
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:
6
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:
1083688287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2015
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:
360-394-7030
Provider Business Mailing Address Fax Number:
360-394-7097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 SETON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT TOWNSEND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98368-9799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-385-2626
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POMEROY
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
360-385-2626

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  16D01 , 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: 0069020 . This is a "L&I AND CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1027804 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590000289 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: JE5741 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 500683499 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611461000 . This is a "OWCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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