=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013756204
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH BEACH REGIONAL FIRE AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2024
-----------------------------------------------------
Last Update Date | 05/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 WEST SPOKANE AVENUE
-----------------------------------------------------
City | WESTPORT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-268-9832
-----------------------------------------------------
Fax | 360-268-1880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1195
-----------------------------------------------------
City | WESTPORT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98595-1195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-268-9832
-----------------------------------------------------
Fax | 360-268-1880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BATTALION CHIEF
-----------------------------------------------------
Name | MR. DARYL BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-268-9832
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------