Healthcare Provider Details

I. General information

NPI: 1013756204
Provider Name (Legal Business Name): SOUTH BEACH REGIONAL FIRE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WEST SPOKANE AVENUE
WESTPORT WA
98595
US

IV. Provider business mailing address

PO BOX 1195
WESTPORT WA
98595-1195
US

V. Phone/Fax

Practice location:
  • Phone: 360-268-9832
  • Fax: 360-268-1880
Mailing address:
  • Phone: 360-268-9832
  • Fax: 360-268-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. DARYL BROWN
Title or Position: BATTALION CHIEF
Credential:
Phone: 360-268-9832