Provider Demographics
NPI:1477645414
Name:CITY OF TACOMA
Entity Type:Organization
Organization Name:CITY OF TACOMA
Other - Org Name:CITY OF TACOMA FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE DEPARTMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-591-5157
Mailing Address - Street 1:901 FAWCETT AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402
Mailing Address - Country:US
Mailing Address - Phone:253-591-5844
Mailing Address - Fax:253-591-5746
Practice Address - Street 1:901 FAWCETT AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:253-591-5844
Practice Address - Fax:253-591-5746
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF TACOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27M163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590007108OtherUHC
WA9032715Medicaid
WA0056986OtherLABOR & INDUSTRIES
WA9032715Medicaid