MEDICARE: PIERCE COUNTY FIRE PROT DIST #17

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	27D17	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590015055	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3560PI	OTHER	WA	REGENCE
4	0153758	OTHER	WA	LABOR & INDUSTRIES
5	8928206	OTHER	WA	CRIME VICTIMS

General Provider Information

NPI Number	:	1518933886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIERCE COUNTY FIRE PROT DIST #17

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

Provider Business Practice Location Address
First Line	:	302 MCNAUGHT ST S
Second Line	:
City	:	ROY
State	:	WA
Zip	:	98580
Country	:	US
Telephone Number	:	253-843-2425
Fax Number	:

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	04/21/2009

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Directions to “PIERCE COUNTY FIRE PROT DIST #17 ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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