Healthcare Provider Details

I. General information

NPI: 1417404930
Provider Name (Legal Business Name): COPALIS CROSSING FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 12/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 OCEAN BEACH RD
COPALIS CROSSING WA
98536
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 360-289-3227
  • Fax:
Mailing address:
  • Phone: 360-394-7010
  • Fax: 360-394-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number14D16
License Number StateWA

VIII. Authorized Official

Name: JODI HARTLE
Title or Position: FIRE CHIEF
Credential:
Phone: 360-289-3227