Healthcare Provider Details

I. General information

NPI: 1649398405
Provider Name (Legal Business Name): SAN JUAN COUNTY FIRE PROTECTION DISTRICT 4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 FISHERMAN BAY RD
LOPEZ ISLAND WA
98261-8676
US

IV. Provider business mailing address

2228 FISHERMAN BAY RD
LOPEZ ISLAND WA
98261-8676
US

V. Phone/Fax

Practice location:
  • Phone: 360-468-2991
  • Fax: 360-468-3716
Mailing address:
  • Phone: 360-468-2991
  • Fax: 360-468-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number28D04
License Number StateWA

VIII. Authorized Official

Name: MR. JAMES P. GHIGLIONE
Title or Position: FIRE CHIEF
Credential:
Phone: 360-468-2991