Healthcare Provider Details

I. General information

NPI: 1053385286
Provider Name (Legal Business Name): PIERCE COUNTY FPD #15
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5403 340TH ST E
EATONVILLE WA
98328-9633
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 253-847-4333
  • 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 Number27D15
License Number StateWA

VIII. Authorized Official

Name: DENNIS CHAFE
Title or Position: FIRE CHIEF
Credential:
Phone: 253-847-4333