Healthcare Provider Details

I. General information

NPI: 1548233372
Provider Name (Legal Business Name): JEFFERSON COUNTY FIRE PROTECTION DISTRICT NO 3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 OAK BAY RD
PORT LUDLOW WA
98365-9634
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 360-437-2236
  • 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 Number16D03
License Number StateWA

VIII. Authorized Official

Name: ED WILKERSON
Title or Position: FIRE CHIEF
Credential:
Phone: 360-437-2236