Provider Demographics
NPI:1073670378
Name:SOUTH BEACH REGIONAL FIRE AUTHORITY
Entity Type:Organization
Organization Name:SOUTH BEACH REGIONAL FIRE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-268-9832
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98595-1195
Mailing Address - Country:US
Mailing Address - Phone:360-268-9832
Mailing Address - Fax:360-268-1880
Practice Address - Street 1:170 WEST SPOKANE STREET
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:WA
Practice Address - Zip Code:98595-1195
Practice Address - Country:US
Practice Address - Phone:360-268-9832
Practice Address - Fax:360-268-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14X033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA90022989Medicaid
WA590008144OtherRAILROAD MEDICARE