Provider Demographics
NPI:1922302678
Name:CITY OF MERCER ISLAND
Entity Type:Organization
Organization Name:CITY OF MERCER ISLAND
Other - Org Name:MERCER ISLAND FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-275-7960
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 1:3030 78TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2823
Practice Address - Country:US
Practice Address - Phone:206-275-7607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17M103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0273247OtherL&I AND CRIME VICTIMS
WAP01063330OtherRAILROAD MEDICARE
WA2011047Medicaid
615777900OtherOWCP
WA0273247OtherL&I AND CRIME VICTIMS