MEDICARE: THURSTON COUNTY FIRE DIST 5

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	34D05	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2762BL	OTHER	WA	REGENCE
2	0171616	OTHER	WA	L&I AND CRIME VICTIMS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336127364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THURSTON COUNTY FIRE DIST 5

Provider Business Mailing Address
First Line	:	PO BOX 3510
Second Line	:
City	:	SILVERDALE
State	:	WA
Zip	:	98383-3510
Country	:	US
Telephone Number	:	360-394-7030
Fax Number	:	360-394-7097

Provider Business Practice Location Address
First Line	:	5911 BLACK LAKE BLVD SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98512-2210
Country	:	US
Telephone Number	:	360-352-7288
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	STEVE NORTH
Credential	:
Telephone Number	:	360-352-7288

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	04/25/2012

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Directions to “THURSTON COUNTY FIRE DIST 5 ” Practice Location

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