MEDICARE: MASON COUNTY FIRE DISTRICT 18

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	23D18	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0172612	OTHER	WA	L&I WORKER'S COMPENSATION
2	8939976	OTHER	WA	L&I CRIME VICTIMS FUND
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639156912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASON COUNTY FIRE DISTRICT 18

Provider Business Mailing Address
First Line	:	240 N STANDSTILL DR S
Second Line	:
City	:	HOODSPORT
State	:	WA
Zip	:	98548-9777
Country	:	US
Telephone Number	:	360-877-9882
Fax Number	:	360-877-6220

Provider Business Practice Location Address
First Line	:	240 N STANDSTILL DR S
Second Line	:
City	:	HOODSPORT
State	:	WA
Zip	:	98548-9777
Country	:	US
Telephone Number	:	360-877-9882
Fax Number	:	360-877-6220

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MIKE MOTT
Credential	:
Telephone Number	:	360-877-9882

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	03/08/2012

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