MEDICARE: CITY OF MERCER ISLAND

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	17M10	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01063330	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0273247	OTHER	WA	L&I AND CRIME VICTIMS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	615777900	OTHER		OWCP

General Provider Information

NPI Number	:	1922302678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF MERCER ISLAND

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	:	3030 78TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2823
Country	:	US
Telephone Number	:	206-275-7607
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	CHRISTIAN D TUBBS
Credential	:
Telephone Number	:	206-275-7960

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	10/11/2012

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Directions to “CITY OF MERCER ISLAND ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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