Provider Demographics
NPI:1508853193
Name:LEWIS COUNTY FIRE PROTECTION DISTRICT 14
Entity Type:Organization
Organization Name:LEWIS COUNTY FIRE PROTECTION DISTRICT 14
Other - Org Name:RANDLE FIRE & EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-497-7745
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 1:9978 US HWY 12
Practice Address - Street 2:
Practice Address - City:RANDLE
Practice Address - State:WA
Practice Address - Zip Code:98377-0127
Practice Address - Country:US
Practice Address - Phone:360-497-7745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21D143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9187006Medicaid
WA29939OtherL&I AND CRIME VICTIMS
WALE9337OtherREGENCE
WAWA00106OtherSUBMITTER NUMBER
WALE9337OtherREGENCE