Provider Demographics
NPI:1417921644
Name:COWLITZ 2 FIRE & RESCUE
Entity Type:Organization
Organization Name:COWLITZ 2 FIRE & RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-575-6298
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 1:701 VINE ST
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-2621
Practice Address - Country:US
Practice Address - Phone:360-575-6298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA08D023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9018466Medicaid
WA0015545OtherLABOR & INDUSTRIES
WACO3487OtherREGENCE
WA337344100OtherFEDERAL OWCP
WA590011341Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WA9018466Medicaid