Provider Demographics
NPI:1710075254
Name:GRANT COUNTY FIRE DISTRICT NO 10
Entity Type:Organization
Organization Name:GRANT COUNTY FIRE DISTRICT NO 10
Other - Org Name:GRANT COUNTY FIRE DISTRICT # 10 AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-346-2658
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:ROYAL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99357-0220
Mailing Address - Country:US
Mailing Address - Phone:509-346-2658
Mailing Address - Fax:509-346-2129
Practice Address - Street 1:336 CAMELIA ST NE
Practice Address - Street 2:
Practice Address - City:ROYAL CITY
Practice Address - State:WA
Practice Address - Zip Code:99357-0220
Practice Address - Country:US
Practice Address - Phone:509-346-2658
Practice Address - Fax:509-346-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA13D103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA84473OtherWASHINGTON L&I
WA9163304Medicaid
WA84473OtherWASHINGTON L&I