Healthcare Provider Details

I. General information

NPI: 1033183678
Provider Name (Legal Business Name): THURSTON COUNTY FPD #11
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10828 LITTLEROCK RD SW
OLYMPIA WA
98512-8525
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 360-352-1614
  • 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 Number34D11
License Number StateWA

VIII. Authorized Official

Name: RUSS KALEIWAHEA
Title or Position: CHIEF
Credential:
Phone: 360-352-1614