Healthcare Provider Details

I. General information

NPI: 1336432079
Provider Name (Legal Business Name): ENUMCLAW FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 WELLS ST
ENUMCLAW WA
98022-2607
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-5544
  • 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 Number17M06
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0280019
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL&I AND CRIME VICTIMS

VIII. Authorized Official

Name: RANDY FEHR
Title or Position: FIRE CHIEF
Credential:
Phone: 360-825-5544