Provider Demographics
NPI:1760517981
Name:JEFFERSON COUNTY FIRE PROTECTION DISTRICT #4
Entity Type:Organization
Organization Name:JEFFERSON COUNTY FIRE PROTECTION DISTRICT #4
Other - Org Name:BRINNON FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN BOARD OF FIRE COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-795-4450
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:BRINNON
Mailing Address - State:WA
Mailing Address - Zip Code:98320-0042
Mailing Address - Country:US
Mailing Address - Phone:360-796-4450
Mailing Address - Fax:360-796-3999
Practice Address - Street 1:272 SCHOOLHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:BRINNON
Practice Address - State:WA
Practice Address - Zip Code:98320
Practice Address - Country:US
Practice Address - Phone:360-796-4450
Practice Address - Fax:360-796-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA16D043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9031576Medicaid
WA57449OtherDEPT OF LABOR & IND