Provider Demographics
NPI:1598737611
Name:MOSSYROCK EMERGENCY SERVICES
Entity Type:Organization
Organization Name:MOSSYROCK EMERGENCY SERVICES
Other - Org Name:LEWIS COUNTY FPD 3
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:CRANSON
Authorized Official - Last Name:FOSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-983-3456
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 1:238 MOSSYROCK ROAD EAST
Practice Address - Street 2:
Practice Address - City:MOSSYROCK
Practice Address - State:WA
Practice Address - Zip Code:98564-9501
Practice Address - Country:US
Practice Address - Phone:360-983-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21D033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006MOOtherREGENCE
WA9046590Medicaid
WA0126418OtherL&I AND CRIME VICTIMS
WAP00238394OtherRAILROAD MEDICARE
WAG8803377Medicare PIN