=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396454740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KING COUNTY FIRE DISTRICT NO 45
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2022
-----------------------------------------------------
Last Update Date | 05/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15600 1ST AVE NE
-----------------------------------------------------
City | DUVALL
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98019-6431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-788-1625
-----------------------------------------------------
Fax | 425-788-0199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 338
-----------------------------------------------------
City | DUVALL
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98019-0338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-788-1625
-----------------------------------------------------
Fax | 425-788-1625
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACTING CHIEF
-----------------------------------------------------
Name | WENDY MOFFATT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-788-1625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PE0004X
-----------------------------------------------------
Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------