Healthcare Provider Details

I. General information

NPI: 1861416471
Provider Name (Legal Business Name): ISLAND COUNTY FPD 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N SUNRISE BLVD
CAMANO ISLAND WA
98282-8778
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 360-387-1512
  • Fax:
Mailing address:
  • Phone: 360-394-7030
  • Fax: 360-394-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number15D01
License Number StateWA

VIII. Authorized Official

Name: MICHAEL GANZ
Title or Position: FIRE CHIEF
Credential:
Phone: 360-387-1512