Provider Demographics
NPI:1932487873
Name:CITY OF BUCKLEY
Entity Type:Organization
Organization Name:CITY OF BUCKLEY
Other - Org Name:CITY OF BUCKLEY FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PREDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-829-1441
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:360-394-7020
Mailing Address - Fax:360-394-7099
Practice Address - Street 1:611 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-9818
Practice Address - Country:US
Practice Address - Phone:360-829-1441
Practice Address - Fax:360-829-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27M023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2048863Medicaid
WA0343971OtherL&I/CRIME VICTIMS
WAG8944029Medicare PIN