=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932487873
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF BUCKLEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2011
-----------------------------------------------------
Last Update Date | 12/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 S DIVISION ST
-----------------------------------------------------
City | BUCKLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98321-9818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-829-1441
-----------------------------------------------------
Fax | 360-829-6415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3510
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-394-7020
-----------------------------------------------------
Fax | 360-394-7099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | ALAN PREDMORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-829-1441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 27M02
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------