Provider Demographics
NPI:1063499432
Name:MASON CO FPD NO 3
Entity Type:Organization
Organization Name:MASON CO FPD NO 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-275-4483
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7030
Mailing Address - Fax:360-394-7097
Practice Address - Street 1:4350 E GRAPEVIEW LOOP RD
Practice Address - Street 2:
Practice Address - City:GRAPEVIEW
Practice Address - State:WA
Practice Address - Zip Code:98546
Practice Address - Country:US
Practice Address - Phone:360-275-4483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA23D033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0107070OtherL&I AND CRIME VICTIMS
WA9043365Medicaid
WA0107070OtherL&I AND CRIME VICTIMS