=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285607796
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF PUYALLUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2006
-----------------------------------------------------
Last Update Date | 05/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 7TH ST NW
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98371-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-845-6666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3510
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-394-7030
-----------------------------------------------------
Fax | 360-394-7097
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL OFFICER
-----------------------------------------------------
Name | MR. RANDY STEPHENS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-845-6666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 27M09
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------