1518933886 NPI number — PIERCE COUNTY FIRE PROT DIST #17

Table of content: (NPI 1518933886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518933886 NPI number — PIERCE COUNTY FIRE PROT DIST #17

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIERCE COUNTY FIRE PROT DIST #17
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:
1518933886
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:
302 MCNAUGHT ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-843-2425
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNT
Authorized Official First Name:
SAM
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT FIRE CHIEF
Authorized Official Telephone Number:
253-377-1963

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  27D17 , 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: 9052150 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3560PI . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 590015055 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0153758 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8928206 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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