Provider Demographics
NPI:1518933886
Name:PIERCE COUNTY FIRE PROT DIST #17
Entity Type:Organization
Organization Name:PIERCE COUNTY FIRE PROT DIST #17
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-377-1963
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 1:302 MCNAUGHT ST S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580
Practice Address - Country:US
Practice Address - Phone:253-843-2425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27D173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9052150Medicaid
WA3560PIOtherREGENCE
WA590015055OtherRAILROAD MEDICARE
WA0153758OtherLABOR & INDUSTRIES
WA8928206OtherCRIME VICTIMS
WA8928206OtherCRIME VICTIMS