Healthcare Provider Details

I. General information

NPI: 1366420341
Provider Name (Legal Business Name): GRANT COUNTY FIRE DISTRICT NO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11058 NELSON ROAD NE
MOSES LAKE WA
98837-8812
US

IV. Provider business mailing address

4251 KIPLING STREET SUITE 200
WHEATRIDGE CO
80033
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-3175
  • Fax: 509-765-3550
Mailing address:
  • Phone: 303-329-9044
  • Fax: 303-336-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number13M18
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number13D05
License Number StateWA

VIII. Authorized Official

Name: ROGER HANSEN
Title or Position: FIRE CHIEF
Credential:
Phone: 509-765-3175