Provider Demographics
NPI:1649398405
Name:SAN JUAN COUNTY FIRE PROTECTION DISTRICT 4
Entity Type:Organization
Organization Name:SAN JUAN COUNTY FIRE PROTECTION DISTRICT 4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:GHIGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-468-2991
Mailing Address - Street 1:2228 FISHERMAN BAY RD
Mailing Address - Street 2:
Mailing Address - City:LOPEZ ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98261-8676
Mailing Address - Country:US
Mailing Address - Phone:360-468-2991
Mailing Address - Fax:360-468-3716
Practice Address - Street 1:2228 FISHERMAN BAY RD
Practice Address - Street 2:
Practice Address - City:LOPEZ ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98261-8676
Practice Address - Country:US
Practice Address - Phone:360-468-2991
Practice Address - Fax:360-468-3716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA28D043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA28D04OtherEMS LICENSE
WA9046061Medicaid
WAG115000594Medicare PIN