Provider Demographics
NPI:1639121742
Name:SNOHOMISH COUNTY FIRE PROTECTION DISTRICT 1
Entity Type:Organization
Organization Name:SNOHOMISH COUNTY FIRE PROTECTION DISTRICT 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-754-5467
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 1:12425 MERIDIAN AVE S
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5728
Practice Address - Country:US
Practice Address - Phone:425-551-1244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA31D013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0113336OtherL&I AND CRIME VICTIMS
WA9043704Medicaid
WA5030SNOtherREGENCE
WAG115001122Medicare PIN
WA590011582Medicare ID - Type UnspecifiedRAILROAD MEDICARE