Provider Demographics
NPI:1104862184
Name:CLALLAM COUNTY FIRE PROT DIST 4
Entity Type:Organization
Organization Name:CLALLAM COUNTY FIRE PROT DIST 4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-928-3132
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:360-394-7020
Mailing Address - Fax:360-394-7099
Practice Address - Street 1:51250 HIGHWAY 112
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-8766
Practice Address - Country:US
Practice Address - Phone:360-928-3132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA05D043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0213981OtherLABOR & INDUSTRIES
WA8942804OtherCRIME VICTIMS
WA4590CLOtherREGENCE
WA9058967Medicaid
WA4590CLOtherREGENCE