MEDICARE: THURSTON COUNTY FPD #11

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	34D11	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0164585	OTHER	WA	L&I AND CRIME VICTIMS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9113LI	OTHER	WA	REGENCE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033183678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THURSTON COUNTY FPD #11

Provider Business Mailing Address
First Line	:	PO BOX 3510
Second Line	:
City	:	SILVERDALE
State	:	WA
Zip	:	98383-3510
Country	:	US
Telephone Number	:	360-394-7030
Fax Number	:	360-394-7097

Provider Business Practice Location Address
First Line	:	10828 LITTLEROCK RD SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98512-8525
Country	:	US
Telephone Number	:	360-352-1614
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	RUSS KALEIWAHEA
Credential	:
Telephone Number	:	360-352-1614

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	05/17/2011

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Directions to “THURSTON COUNTY FPD #11 ” Practice Location

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