Provider Demographics
NPI:1346017944
Name:NORTH MASON REGIONAL FIRE AUTHORITY
Entity Type:Organization
Organization Name:NORTH MASON REGIONAL FIRE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BAKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-275-6711
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-0277
Mailing Address - Country:US
Mailing Address - Phone:360-275-6711
Mailing Address - Fax:
Practice Address - Street 1:490 NE OLD BELFAIR HWY
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9637
Practice Address - Country:US
Practice Address - Phone:360-275-6711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty