=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467732495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KING COUNTY FIRE DISTRICT 20
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2011
-----------------------------------------------------
Last Update Date | 08/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12424 76TH AVE S
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98178-4809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-772-1430
-----------------------------------------------------
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 | DAVID L CROSSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-772-1430
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 17D20
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------