Provider Demographics
NPI:1598731580
Name:MASON COUNTY FPD #2
Entity Type:Organization
Organization Name:MASON COUNTY FPD #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-275-6711
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 1:460 NE OLD BELFAIR HWY
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9637
Practice Address - Country:US
Practice Address - Phone:360-275-6711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA23D023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA5224OtherREGENCE
WA0076518OtherLABOR & INDUSTRIES
WA8913847OtherCRIME VICTIMS
WA9027681Medicaid
WA8913847OtherCRIME VICTIMS