Provider Demographics
NPI:1154308534
Name:FIRE PROTECTION DIST 5 MASON COUNTY
Entity Type:Organization
Organization Name:FIRE PROTECTION DIST 5 MASON COUNTY
Other - Org Name:CENTRAL MASON FIRE & EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCKERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-426-5533
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 1:122 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3511
Practice Address - Country:US
Practice Address - Phone:360-426-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA23D053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1003569Medicaid
WA0016021OtherL&I WORKERS COMPENSATION
WA590005425OtherRAILROAD MEDICARE
WAG000200002Medicare PIN