Provider Demographics
NPI:1225279847
Name:SOUTH PIERCE FIRE AND RESCUE DISTRICT NO 17
Entity Type:Organization
Organization Name:SOUTH PIERCE FIRE AND RESCUE DISTRICT NO 17
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-847-4333
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:360-613-1627
Mailing Address - Fax:360-698-4968
Practice Address - Street 1:5403 340TH ST E
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328-9633
Practice Address - Country:US
Practice Address - Phone:253-847-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590015055OtherRAILROAD MEDICARE
WA9063223Medicaid
WA0250027OtherL&I/CRIME VICTIMS
AKGA001WAMedicaid
WA0250027OtherL&I/CRIME VICTIMS