Healthcare Provider Details

I. General information

NPI: 1740422666
Provider Name (Legal Business Name): COUNTY OF GRANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 CAMELIA ST NW
ROYAL CITY WA
99357
US

IV. Provider business mailing address

PO BOX 1770
REDMOND OR
97756-0519
US

V. Phone/Fax

Practice location:
  • Phone: 509-346-2658
  • Fax: 509-346-2129
Mailing address:
  • Phone: 509-346-2658
  • Fax: 509-346-2129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number13D10
License Number StateWA

VIII. Authorized Official

Name: MR. BRIAN EVANS
Title or Position: FIRE CHIEF
Credential:
Phone: 509-346-2658