Provider Demographics
NPI:1568434348
Name:COWLITZ COUNTY FIRE DISTRICT 5
Entity Type:Organization
Organization Name:COWLITZ COUNTY FIRE DISTRICT 5
Other - Org Name:KALAMA FIRE & AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-673-2222
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 1:382 NE FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:KALAMA
Practice Address - State:WA
Practice Address - Zip Code:98625
Practice Address - Country:US
Practice Address - Phone:360-673-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA08D053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1029744Medicaid
WA590014531OtherRAILROAD MEDICARE PTAN
WA615281300OtherOWCP
WA0109943OtherL&I AND CRIME VICTIMS
WAKA3487OtherREGENCE
OR275131Medicaid
OR275131Medicaid