Provider Demographics
NPI:1326291071
Name:MARYSVILLE FIRE DISTRICT
Entity Type:Organization
Organization Name:MARYSVILLE FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-363-8501
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 1:1094 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4233
Practice Address - Country:US
Practice Address - Phone:360-363-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA31M083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGA003WAMedicaid
615388100OtherOWCP ENERGY
AZ499846Medicaid
WA9039413Medicaid
WAP00682893OtherRAILROAD MEDICARE
615388100OtherOWCP
OR500616219Medicaid
WA0024896OtherL&I AND CRIME VICTIMS
WA9039413Medicaid