=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457328973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIERCE COUNTY FIRE DISTRICT 14
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2006
-----------------------------------------------------
Last Update Date | 06/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4114 56TH AVENUE E
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-922-5644
-----------------------------------------------------
Fax | 253-252-7941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2029
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-4029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-922-5644
-----------------------------------------------------
Fax | 253-252-7941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | ANTHONY COOPER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-922-5644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 27D14
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------