Healthcare Provider Details

I. General information

NPI: 1073670378
Provider Name (Legal Business Name): SOUTH BEACH REGIONAL FIRE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 WEST SPOKANE STREET
WESTPORT WA
98595-1195
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 Number14X03
License Number StateWA

VIII. Authorized Official

Name: DIANE MCNETT
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 360-268-9832