Provider Demographics
NPI:1104033240
Name:BENTON COUNTY FIRE DIST NO 2
Entity Type:Organization
Organization Name:BENTON COUNTY FIRE DIST NO 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:509-588-3212
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:360-394-7010
Mailing Address - Fax:360-394-7099
Practice Address - Street 1:1304 DALE AVE
Practice Address - Street 2:
Practice Address - City:BENTON CITY
Practice Address - State:WA
Practice Address - Zip Code:99320-8831
Practice Address - Country:US
Practice Address - Phone:509-588-3212
Practice Address - Fax:509-588-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA03D023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1027588Medicaid
618410900OtherOWCP - FEDERAL WORKER'S COMP
WAG000300093Medicare PIN