Healthcare Provider Details

I. General information

NPI: 1104862184
Provider Name (Legal Business Name): CLALLAM COUNTY FIRE PROT DIST 4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51250 HIGHWAY 112
PORT ANGELES WA
98363-8766
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 360-928-3132
  • Fax:
Mailing address:
  • Phone: 360-394-7020
  • Fax: 360-394-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number05D04
License Number StateWA

VIII. Authorized Official

Name: GREGORY THOMAS WATERS
Title or Position: FIRE CHIEF
Credential:
Phone: 360-928-3132