Healthcare Provider Details

I. General information

NPI: 1679956064
Provider Name (Legal Business Name): LEWIS COUNTY FIRE PROTECTION DISTRICT NUMBER 15
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 NW KERRON ST
WINLOCK WA
98596-9450
US

IV. Provider business mailing address

PO BOX 708
WINLOCK WA
98596-0708
US

V. Phone/Fax

Practice location:
  • Phone: 360-785-4221
  • Fax:
Mailing address:
  • Phone: 360-785-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberAMBV.ES.00000396
License Number StateWA

VIII. Authorized Official

Name: RICHARD UNDERDAHL
Title or Position: CHIEF
Credential:
Phone: 360-269-2887