Healthcare Provider Details

I. General information

NPI: 1326025677
Provider Name (Legal Business Name): WALLA WALLA COUNTY FIRE PROTECTION DISTRICT NO 5
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 WEST HUMORIST ROAD
BURBANK WA
99323
US

IV. Provider business mailing address

460 WEST HUMORIST ROAD
BURBANK WA
99323
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-8341
  • Fax: 509-547-3533
Mailing address:
  • Phone: 509-547-8341
  • Fax: 509-547-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number601138641
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number36D05
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name: MIKE WICKSTROM
Title or Position: FIRE CHIEF
Credential:
Phone: 509-547-8341