Provider Demographics
NPI:1235228842
Name:SNOHOMISH COUNTY FIRE DISTRICT 28
Entity Type:Organization
Organization Name:SNOHOMISH COUNTY FIRE DISTRICT 28
Other - Org Name:INDEX FIRE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:360-793-0866
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 1:512 AVENUE A
Practice Address - Street 2:
Practice Address - City:INDEX
Practice Address - State:WA
Practice Address - Zip Code:98256-9800
Practice Address - Country:US
Practice Address - Phone:360-793-0866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA31D283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA616544400OtherOWCP
WA0256468OtherL&I-CRIME VICTIMS
WA1043389Medicaid
WAGAB20524Medicare PIN