Healthcare Provider Details

I. General information

NPI: 1083297154
Provider Name (Legal Business Name): PUGET SOUND REGIONAL FIRE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24611 116TH AVE SE
KENT WA
98030-4939
US

IV. Provider business mailing address

24611 116TH AVE SE
KENT WA
98030-4939
US

V. Phone/Fax

Practice location:
  • Phone: 253-856-4300
  • Fax: 253-856-6300
Mailing address:
  • Phone: 253-856-4300
  • Fax: 253-856-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: AARON MICHAEL TYERMAN
Title or Position: DEPUTY CHIEF
Credential:
Phone: 253-856-4300