=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336127364
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THURSTON COUNTY FIRE DIST 5
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2006
-----------------------------------------------------
Last Update Date | 04/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5911 BLACK LAKE BLVD SW
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98512-2210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-352-7288
-----------------------------------------------------
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 | FIRE CHIEF
-----------------------------------------------------
Name | STEVE NORTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-352-7288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 34D05
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------