Provider Demographics
NPI:1083688287
Name:JEFFERSON COUNTY FIRE PROTECTION DISTRICT 1 JEFFERSON COUNTY
Entity Type:Organization
Organization Name:JEFFERSON COUNTY FIRE PROTECTION DISTRICT 1 JEFFERSON COUNTY
Other - Org Name:EAST JEFFERSON FIRE RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:POMEROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-385-2626
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 1:24 SETON RD
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-9799
Practice Address - Country:US
Practice Address - Phone:360-385-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA16D013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0069020OtherL&I AND CRIME VICTIMS
WA1027804Medicaid
WA590000289OtherRAILROAD MEDICARE PTAN
WAJE5741OtherREGENCE
OR500683499Medicaid
WA611461000OtherOWCP
OR500683499Medicaid