Healthcare Provider Details

I. General information

NPI: 1710075254
Provider Name (Legal Business Name): GRANT COUNTY FIRE DISTRICT NO 10
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 CAMELIA ST NE
ROYAL CITY WA
99357-0220
US

IV. Provider business mailing address

PO BOX 220
ROYAL CITY WA
99357-0220
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 Code3416L0300X
TaxonomyLand Ambulance
License Number13D10
License Number StateWA

VIII. Authorized Official

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