Healthcare Provider Details

I. General information

NPI: 1174954119
Provider Name (Legal Business Name): NORTH MASON REGIONAL FIRE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 NE OLD BELFAIR HWY
BELFAIR WA
98528-9637
US

IV. Provider business mailing address

PO BOX 277
BELFAIR WA
98528-0277
US

V. Phone/Fax

Practice location:
  • Phone: 360-275-6711
  • Fax:
Mailing address:
  • Phone: 360-275-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateWA

VIII. Authorized Official

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