Provider Demographics
NPI:1437121563
Name:JEFFERSON COUNTY FIRE PROTECTION DISTRICT 5
Entity Type:Organization
Organization Name:JEFFERSON COUNTY FIRE PROTECTION DISTRICT 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOEPFLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-379-6839
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 1:12 BENTLEY PL
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-8725
Practice Address - Country:US
Practice Address - Phone:360-379-6839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA16D053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0072596OtherL&I AND CRIME VICTIMS
WA9034026Medicaid
WA8940266OtherCRIME VICTIMS
WAJE1168OtherREGENCE
WA9034026Medicaid