Healthcare Provider Details

I. General information

NPI: 1598731580
Provider Name (Legal Business Name): MASON COUNTY FPD #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 NE OLD BELFAIR HWY
BELFAIR WA
98528-9637
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 360-275-6711
  • Fax:
Mailing address:
  • Phone: 360-613-1627
  • Fax: 360-698-4968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number23D02
License Number StateWA

VIII. Authorized Official

Name: BEAU BAKKEN
Title or Position: FIRE CHIEF
Credential:
Phone: 360-275-6711