Healthcare Provider Details

I. General information

NPI: 1134343254
Provider Name (Legal Business Name): SNOHOMISH COUNTY FIRE DISTRICT 17
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S. GRANITE AVENUE
GRANITE FALLS WA
98252
US

IV. Provider business mailing address

PO BOX 12383
MILL CREEK WA
98082-0383
US

V. Phone/Fax

Practice location:
  • Phone: 360-691-5553
  • Fax: 360-691-7837
Mailing address:
  • Phone: 360-282-3964
  • Fax: 360-282-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number31D17
License Number StateWA

VIII. Authorized Official

Name: JIM HAVERFIELD
Title or Position: FIRE CHIEF
Credential:
Phone: 360-691-5553